Early extubation and weaning with bilevel positive airway pressure ventilation after cardiac surgery (Weaning with BiPAP ventilation after cardiac surgery)

Objective(s): To evaluate the use of bilevel positive airway pressure (BiPAP) ventilation in early extubation after fast-track cardiac surgery.Design: Prospective observational study.Setting: Postoperative intensive care.Patients: Sixty consecutive patients eligible for early extubation after cardiac surgery. Patients were predominantly male (42 men [70%]) and middle aged (54.62 ± 10.66 years).Interventions: Patients were randomly assigned to continuous pressure or BiPAP (Group I or Group II, respectively) and were extubated as soon as possible.Measurements: Blood gases and haemodynamics were determined on arrival in the ICU (baseline, or T0) and 1, 2, 4, 6, 8, and 12 hours later. All data were expressed as (±SD) and analysed using the Student t-test and Mann-Whitney test (continuous data) or χ2 test (categorical data). P < 0.05 was considered statistically significant.Main results: PaCO2 levels were statistically significantly higher in Group II than in Group I at 2, 4, 6, 8, and 12 hours (P < 0.05, P < 0.01). Within each group, PaCO2 levels were statistically significantly higher at 4, 6, 8, and 12 hours than at baseline (P < 0.01 ).Extubation time was significantly longer in Group I than in Group II 7.90 (7.90 [2.13] vs 3.83 [1.20], P=0.001). Respiratory rates were significantly higher in Group II than in Group I after 2, 4, and 6 hours (P < 0.01). Pmax was higher in Group I than in Group II after 1 hour but similar up to 4 hours.Conclusions: Early extubation and weaning to BiPAP ventilation after cardiac surgery is safe and effective