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Elective nasal continuous positive airway pressure to support respiration after prolonged ventilation in infants after congenital cardiac surgery


1 Department of Anesthesia, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Ahmedabad, Gujarat, India
2 Department of Cardiovascular Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Ahmedabad, Gujarat, India
3 Department of Research, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Ahmedabad, Gujarat, India
4 Department of Pediatric Critical Care, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Ahmedabad, Gujarat, India

Correspondence Address:
Hemang Gandhi
Department of Anesthesia, U. N. Mehta Institute of Cardiology and Research Center, (Affiliated to B.J. Medical College), New Civil Hospital Campus, Asarwa, Ahmedabad - 380 016, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2069.197055

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Year : 2017  |  Volume : 10  |  Issue : 1  |  Page : 26-30

 

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Background: We sought to compare the effectiveness of oxygen (O2) treatment administered by an O2 mask and nasal continuous positive airway pressure (NCPAP) in infants after congenital cardiac surgery. Methods: In this retrospective observational study, 54 infants undergoing corrective cardiac surgery were enrolled. According to the anesthesiologist's preference, the patients ventilated for more than 48 h were either put on NCPAP or O2 mask immediately after extubation. From pre-extubation to 24 h after treatment, arterial blood gas and hemodynamic data were measured. Results: After 24 h of NCPAP institution, the patients showed a significant improvement in oxygenation compared to O2 mask group. Respiratory rate (per minute) decreased from 31.67 ± 4.55 to 24.31 ± 3.69 (P < 0.0001), PO2 (mmHg) increased from 112.12 ± 22.83 to 185.74 ± 14.81 (P < 0.0001), and PCO2 (mmHg) decreased from 42.88 ± 5.01 to 37.00 ± 7.22 (P < 0.0076) in patients on NCPAP. In this group, mean pediatric cardiac surgical Intensive Care Unit (PCSICU) stay was 4.72 ± 1.60 days, with only 2 (11.11%) patients requiring re-intubation. Conclusion: NCPAP can be used safely and effectively in infants undergoing congenital cardiac surgery to improve oxygenation/ventilation. It also reduces the work of breathing, PCSICU stay, and may reduce the likelihood of re-intubation.






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1 Department of Anesthesia, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Ahmedabad, Gujarat, India
2 Department of Cardiovascular Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Ahmedabad, Gujarat, India
3 Department of Research, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Ahmedabad, Gujarat, India
4 Department of Pediatric Critical Care, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Ahmedabad, Gujarat, India

Correspondence Address:
Hemang Gandhi
Department of Anesthesia, U. N. Mehta Institute of Cardiology and Research Center, (Affiliated to B.J. Medical College), New Civil Hospital Campus, Asarwa, Ahmedabad - 380 016, Gujarat
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2069.197055

Rights and Permissions

Background: We sought to compare the effectiveness of oxygen (O2) treatment administered by an O2 mask and nasal continuous positive airway pressure (NCPAP) in infants after congenital cardiac surgery. Methods: In this retrospective observational study, 54 infants undergoing corrective cardiac surgery were enrolled. According to the anesthesiologist's preference, the patients ventilated for more than 48 h were either put on NCPAP or O2 mask immediately after extubation. From pre-extubation to 24 h after treatment, arterial blood gas and hemodynamic data were measured. Results: After 24 h of NCPAP institution, the patients showed a significant improvement in oxygenation compared to O2 mask group. Respiratory rate (per minute) decreased from 31.67 ± 4.55 to 24.31 ± 3.69 (P < 0.0001), PO2 (mmHg) increased from 112.12 ± 22.83 to 185.74 ± 14.81 (P < 0.0001), and PCO2 (mmHg) decreased from 42.88 ± 5.01 to 37.00 ± 7.22 (P < 0.0076) in patients on NCPAP. In this group, mean pediatric cardiac surgical Intensive Care Unit (PCSICU) stay was 4.72 ± 1.60 days, with only 2 (11.11%) patients requiring re-intubation. Conclusion: NCPAP can be used safely and effectively in infants undergoing congenital cardiac surgery to improve oxygenation/ventilation. It also reduces the work of breathing, PCSICU stay, and may reduce the likelihood of re-intubation.






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