Abstract
Background: The use of non-invasive ventilation (NIV) after coronary artery bypass grafting
(CABG) may help reduce loss of functional capacity and complications in patients. However, the
evidence regarding its immediate versus conventional use is controversial.
Aim: The aim of the study was to assess the impact of immediate NIV after extubation on
oxygenation and the functional capacity of patients undergoing CABG.
Methods: This study was a randomized clinical trial involving patients of both sexes, aged 18 years
or older, who have undergone elective CABG with median sternotomy and cardiopulmonary bypass.
Patients were assessed before and after surgery using the Functional Independence Measure (FIM),
6-min walk test (6MWT), and the Medical Research Council (MRC) scale for peripheral muscle
strength. On the 1st day after the surgery, two groups were formed: immediate NIV (NIVI) and
conventional NIV (NIVC). Hemogasometry was performed before and after NIV, and complication
rates were assessed. NIVI was administered 1 h after orotracheal extubation, while NIVC was
performed on the first post-operative day, 24 h after extubation. After discharge, the above variables
were re-evaluated.
Results: A total of 79 patients were evaluated; 46 (58.22%) were men, with a mean age of 65
± 9 years. NIVI reduced the reintubation rate in one patient (3%) compared to NIVC with five
patients (12%) (p = 0.01). In the post-intervention period, the inspired oxygen fraction (FIO2) was
0.43 ± 0.07 in the NIVC group and 0.30 ± 0.10 in the NIVI group (p = 0.01). The post-intervention
PaO2/FIO2 ratio was 191 ± 45 in the NIVC group and 266 ± 29 in the NIVI group (p < 0.001); the
ratio one day later was 210 ± 39 in the NIVC group and 279 ± 37 in the NIVI group (p < 0.001).
From the 6MWT, the INVI group reported a reduction of 51 ± 36 m compared to a reduction of 95
± 40 m in the NIVC group (p < 0.01).
Conclusion: NIVI after extubation of patients undergoing CABG reduced the loss of functional
capacity, improved blood gas levels, and decreased the rate of reintubation.
Relevance for Patients: This study suggests that the use of NIVI after extubation in patients
undergoing CABG may improve recovery, preserve lung function, and reduce complications such
as reintubation.
DOI: http://doi.org/10.36922/jctr.24.00011
Author affiliation
1Department of Physiotherapy, Nobre University Center, Feira de Santana, Bahia, Brazil
2Noble Institute of Cardiology, Feira de Santana,
Bahia, Brazil
3Department of Cardiology and Cardiovascular Surgery, Sao Paulo Hospital, Federal University of Sao Paulo, São Paulo, Brazil
4Department of Medicine and Physiotherapy, Catholic University of Pelotas, Porto Alegre, Rio Grande do Sul, Brazil
*Corresponding author:
André Luiz Lisboa Cordeiro
Department of Physiotherapy, Nobre
University Center, 2116 - Centro, Feira de
Santana, Bahia, 44001-008, Brazil
Email: andre.cordeiro@grupponobre.net
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