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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 X2 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.

southern african journal of anaesthesia and analgesia

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