Preventive and therapeutic noninvasive ventilation in cardiovascular surgery.

PURPOSE OF REVIEW: Postoperative pulmonary complications are common after cardiac and vascular surgery, and they are associated with a marked worsening in hospital survival and length of stay. Noninvasive ventilation (NIV) has been successfully applied in the prevention and treatment of postoperative acute respiratory failure (ARF), including the cardiovascular setting.

RECENT FINDINGS: Recent findings confirm that ARF is still highly associated with reintubation and ICU readmission, affecting hospital and long-term mortality. The most recent studies suggest that NIV can be effective both in early and in severe ARF, both in ICU and in surgical ward; on the contrary, NIV efficacy, when applied as a preventive tool in unselected patients, is not demonstrated. Limited but promising data are available on NIV use in pediatric patients and in ancillary procedures like coronarography and transesophageal echocardiography.

SUMMARY: NIV seems effective when applied to treat postoperative ARF. Its role as a preventive tool is still controversial, and probably should be limited to high-risk patients. Promising findings were reported for NIV application in pediatric patients and in ancillary procedures. So far, a cautious approach should be applied, as NIV failure is associated with poor outcomes if not quickly detected.