Noninvasive Ventilation Bundle in Postoperative Respiratory Failure
Condition: Respiratory Insufficiency
MeSH terms: Respiratory Insufficiency
Study type: Interventional

Summary: 
      The investigators assessed the efficacy and safety of this noninvasive Ventilation (NIV)
      bundle strategy compared with a conventional treatment in postoperative patients with ARF.
    

Detailed description: 
      This is a randomized, prospective, open-label study. Postoperative patients with ARF included
      in the study were randomly assigned to intervention group or conventional treatment group. In
      the intervention group, NIV was early used for treatment of postoperative respiratory
      failure, if patients were inability to spontaneously clear airways from excessive secretions
      during NIV, fiberoptic bronchoscopy (FBO) was used for suction of secretions , if patients
      showed intolerance or inadequate patient cooperation during the NIV session, they were
      sedated (Ramsay scale 2-3) by a continuous perfusion of propofol during the NIV session.

      Patients assigned to the control group received supplemental oxygen, Respiratory therapists
      delivered this intervention using conventional masks or venturi oxygen, and adjusted FiO2 to
      achieve arterial O2 saturation of more than 92%. The application of noninvasive ventilation
      was considered, if patients failed the supplemental oxygen and met at least two of the
      following criteria:(1) severe respiratory distress with dyspnoea, respiratory
      rate>30breaths/min, and clinical signs suggestive of respiratory-muscle fatigue or increased
      respiratory effort (use of accessory respiratory muscles or paradoxical abdominal breathing,
      or intercostal indrawing), (2) respiratory acidosis (arterial pH of 7.35 or less with PaCO2
      of 45 mm Hg or more) ;(3) arterial O2 saturation by pulse oximetry less than 90% or PaO2 less
      than 60 mm Hg at an FiO2> 0.5 or breathing at least 10 l/min oxygen.

      All the patients were continuous monitored of vital signs.whereas arterial blood gases were
      analyzed before NIV and 1h after NIV, before and after FBO, and once a day and in the case of
      any change either in the ventilatory settings or in the FIO2; duration of noninvasive
      ventilation, the rate and cause of endotracheal intubation, ICU and hospital mortality and
      length of stay in the ICU and in hospital, study procedure related complications.
    

Intervention name(s): Early application of NIV; Fiberoptic bronchoscopy; Propofol; Conventional application of NIV
Intervention type(s): Other; Device; Drug; Other
Intervention description(s): Device:BiPAP Vision.
NIV bundle group : Early application of NIV(BiPAP Vision) in 1 h after randomization.; Device:fiberoptic bronchoscopy. NIV bundle group :When patients were inability to spontaneously clear airways from excessive secretions during NIV, fiberoptic bronchoscopy (FBO) was used for suction of secretions.; Drug:propofol.continuous perfusion of propofol (0.50-2.00 mg/kg/h).
NIV bundle group :When patients showed intolerance or inadequate patient cooperation during the NIV session, they were sedated (Ramsay scale 2-3) by a continuous perfusion of propofol (0.50-2.00 mg/kg/h).
In the conventional treatment group: No intervention.; Conventional treatment group:NIV(BiPAP Vision) was used, when patients failed the supplemental oxygen and met at least two of the following criteria:(1) severe respiratory distress with dyspnoea, respiratory rate>30breaths/min, and clinical signs suggestive of respiratory-muscle fatigue or increased respiratory effort (use of accessory respiratory muscles or paradoxical abdominal breathing, or intercostal indrawing), (2) respiratory acidosis (arterial pH of 7.35 or less with PaCO2 of 45 mm Hg or more) ;(3) arterial O2 saturation by pulse oximetry less than 90% or PaO2 less than 60 mm Hg at an FiO2> 0.5 or breathing at least 10 L/min oxygen.
Other intervention name(s): Early application of BiPAP Vision (Respironics); Diprivan; Conventional application of BiPAP Vision (Respironics)
Intervention MeSH terms: Propofol
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment