| Nasal continuous positive airway pressure: A method to avoid endotracheal reintubation in postoperative high-risk patients with severe nonhypercapnic oxygenation failure. | |
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MedLine Citation:
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PMID: 10767248 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To study whether nasal continuous positive airway pressure (nCPAP) improves pulmonary oxygen transfer and avoids reintubation in patients with severe nonhypercapnic oxygenation failure after major cardiac, vascular, or abdominal surgery. DESIGN: Prospective interventional study. SETTING: Surgical ICU of a university hospital. PATIENTS: Twenty consecutive patients after thoracic, abdominal, or combined thoracoabdominal operations, in whom pulmonary oxygen transfer deteriorated continuously following elective extubation after initial mechanical ventilation. Respiratory failure was due to atelectasis and/or left heart failure, and all patients met predefined criteria for reintubation. INTERVENTIONS: nCPAP therapy (8 to 10 cm H(2)O) was initiated if PaO(2) had decreased to < 80 mm Hg despite application of 100% oxygen (flow, 25 L/min), intermittent mask continuous positive airway pressure, and maximum conventional therapy. Measurements and results: nCPAP treatment was started 24.1 +/- 3.4 h after elective extubation. PaO(2) was < 80 mm Hg in all patients, in 13 patients it was < 60 mm Hg, and in 3 patients it was < 50 mm Hg. Mean PaO(2)/fraction of inspired oxygen (FIO(2)) ratio had decreased to 60 +/- 2.6, and increased within the first hour of nCPAP to 136 +/- 12 (p < 0.001). The clinical condition in all patients improved further, and after 35.2 +/- 6.3 h, all patients were well oxygenated by face mask at ambient pressure (PaO(2)/FIO(2) ratio, 146 +/- 14). Two patients were reintubated for reasons unrelated to oxygenation or ventilation (data are presented as mean +/- SEM). CONCLUSIONS: nCPAP is safe, easy to apply, and effective to improve arterial blood oxygenation in < 1 h in postoperative patients with severe nonhypercapnic oxygenation failure. In these patients, who otherwise would have been reintubated, nCPAP can avoid endotracheal reintubation and mechanical ventilation. |
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Authors:
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D Kindgen-Milles; R Buhl; A Gabriel; H Böhner; E Müller |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Chest Volume: 117 ISSN: 0012-3692 ISO Abbreviation: Chest Publication Date: 2000 Apr |
Date Detail:
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Created Date: 2000-05-11 Completed Date: 2000-05-11 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1106-11 Citation Subset: AIM; IM |
Affiliation:
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Department of Clinical Anesthesiology, Heinrich-Heine-University Düsseldorf, Germany. kindgen@uni-duesseldorf.de |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Blood Gas Analysis Female Heart Failure / complications, surgery Hospitals, University Humans Intubation, Intratracheal* Male Middle Aged Nose Oxygen / metabolism* Oxygen Inhalation Therapy / methods* Positive-Pressure Respiration / methods* Postoperative Care / methods* Prospective Studies Pulmonary Atelectasis / complications, surgery Pulmonary Diffusing Capacity Respiratory Care Units Respiratory Insufficiency / etiology, metabolism, therapy* Treatment Failure |
| Chemical | |
Reg. No./Substance:
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7782-44-7/Oxygen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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