Volume 19 Supplement 1

35th International Symposium on Intensive Care and Emergency Medicine

Open Access

Early postoperative use of CPAP reduces need for unplanned IPPV in elective vascular patients

  • H Kennedy1,
  • J Navein1 and
  • J Seidel1
Critical Care201519(Suppl 1):P219

https://doi.org/10.1186/cc14299

Published: 16 March 2015

Introduction

Respiratory failure is a well-known complication of aortic aneurysm surgery. We describe the impact of a protocol, using CPAP after elective surgery to reduce the need for unplanned invasive ventilation.

Methods

In 2012 we introduced a CPAP protocol for patients undergoing elective aortic aneurysm surgery, either open (AAA) or as an endovascular repair (EVAR). According to pre-existing risk factors (see Table 1) and arterial blood gas analysis in the anaesthetic room, they were assigned to two alternative options on the ITU: prophylactic CPAP for 9 hours in each of the first two postoperative nights or oxygen via face mask. CPAP was applied at any time in the patients stay, if their P/F ratio dropped below 40. Criteria to stop CPAP were also predefined. Previously, CPAP was initiated at the discretion of nursing staff, P/F ratios were not utilised.
Table 1

Criteria for the use of prophylactic CPAP.

Current smoker

FEV1: <1.5 l/minute

Poor exercise tolerance (<100 yards) due to chest problems

SpO2 <92% on air

SpO2 <92% on FiO2 >0.4 in theatre

Results

We compare patient cohorts in the years 2010 and 2011 (pre protocol) with 2013 and 2014 (post protocol). Results are reported as the split between open surgery and endovascular repair. Table 2 presents requirements for invasive ventilation (IPPV) and length of stay (LOS) for both patient groups.
Table 2

IPPV requirements and length of stay data 2010 to 2011 2013 to 2014.

 

2010 to 2011

 

2013 to 2014

 

IPPV

LOS ITU (days)

LOS hospital (days)

IPPV

LOS ITU (days)

LOS hospital (days)

EVAR

2/67 (3%)

2

6

1/77 (1.3%)

2

5

AAA

10/46 (21.7%)

5

9

6/37 (16.2%)

5

12

 

Conclusion

There is a clear reduction in the need for unplanned IPPV in both patient groups. An audit in 2013 showed incomplete protocol adherence in the ITU, therefore benefits may be underestimated.

Authors’ Affiliations

(1)
Doncaster Royal Infirmary

Copyright

© Kennedy et al.; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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