Marion Goret, Kevin Pluchon, Raphaël Le Mao, Ali Badra, Jean-Ferréol Oilleau, Yohann Morvan, Marc Beaumont, Gwenaëlle Desanglois, Marie Guegan, Aude Barnier, Christophe Gut-Gobert, Cécile Tromeur, Christophe Leroyer, Jean-Noël Choplain, Ahmed Khalifa, Eric Bezon, Francis Couturaud
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Use of noninvasive ventilation (NIV) may reduce the incidence of pulmonary or heart failure, or both.</p><p><strong>Research question: </strong>Is the use of NIV before and after cardiac surgery associated with a lower rate of acute pulmonary and heart failure in patients at risk of postoperative complications?</p><p><strong>Study design and methods: </strong>We designed a prospective, randomized, monocentric trial comparing preoperative and postoperative NIV in cardiac surgery with standard care. Adult patients classified as being at risk of postoperative cardiac or pulmonary failure were allocated to receive NIV for 5 days before and 5 days after surgery in addition to usual care vs usual care alone. The primary outcome was the composite of predefined and adjudicated cardiorespiratory failure at 1 month after cardiac surgery.</p><p><strong>Results: </strong>Two hundred sixteen patients were included. During the 1-month follow-up period after surgery, the composite outcome occurred in 59 of 107 patients (55.1%) in the NIV group and in 87 of 109 patients (79.8%) in the no NIV group (relative risk, 0.69; 95% CI, 0.57-0.84; P < .001). The benefit persisted at 3 months. No difference between the two groups was found in terms of intubation need and length of hospital stay in cardiac and pulmonary surgery ICUs and in cardiac and pulmonary surgery units.</p><p><strong>Interpretation: </strong>The use of NIV before and after cardiac surgery reduces the rate of cardiopulmonary failure after high-risk cardiac surgery.</p><p><strong>Clinical trial registry: </strong>ClinicalTrials.gov; No.: NCT02302300; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5000,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Noninvasive Ventilation Before and After Cardiac Surgery for Preventing Cardiac and Pulmonary Complications: A Clinical Randomized Trial.\",\"authors\":\"Marion Goret, Kevin Pluchon, Raphaël Le Mao, Ali Badra, Jean-Ferréol Oilleau, Yohann Morvan, Marc Beaumont, Gwenaëlle Desanglois, Marie Guegan, Aude Barnier, Christophe Gut-Gobert, Cécile Tromeur, Christophe Leroyer, Jean-Noël Choplain, Ahmed Khalifa, Eric Bezon, Francis Couturaud\",\"doi\":\"10.1016/j.chest.2025.02.010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The immediate postoperative period after heart surgery poses a substantial risk of life-threatening complications, notably acute pulmonary and cardiac failure. Use of noninvasive ventilation (NIV) may reduce the incidence of pulmonary or heart failure, or both.</p><p><strong>Research question: </strong>Is the use of NIV before and after cardiac surgery associated with a lower rate of acute pulmonary and heart failure in patients at risk of postoperative complications?</p><p><strong>Study design and methods: </strong>We designed a prospective, randomized, monocentric trial comparing preoperative and postoperative NIV in cardiac surgery with standard care. Adult patients classified as being at risk of postoperative cardiac or pulmonary failure were allocated to receive NIV for 5 days before and 5 days after surgery in addition to usual care vs usual care alone. The primary outcome was the composite of predefined and adjudicated cardiorespiratory failure at 1 month after cardiac surgery.</p><p><strong>Results: </strong>Two hundred sixteen patients were included. During the 1-month follow-up period after surgery, the composite outcome occurred in 59 of 107 patients (55.1%) in the NIV group and in 87 of 109 patients (79.8%) in the no NIV group (relative risk, 0.69; 95% CI, 0.57-0.84; P < .001). The benefit persisted at 3 months. No difference between the two groups was found in terms of intubation need and length of hospital stay in cardiac and pulmonary surgery ICUs and in cardiac and pulmonary surgery units.</p><p><strong>Interpretation: </strong>The use of NIV before and after cardiac surgery reduces the rate of cardiopulmonary failure after high-risk cardiac surgery.</p><p><strong>Clinical trial registry: </strong>ClinicalTrials.gov; No.: NCT02302300; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>\",\"PeriodicalId\":9782,\"journal\":{\"name\":\"Chest\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":9.5000,\"publicationDate\":\"2025-02-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Chest\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.chest.2025.02.010\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chest","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.chest.2025.02.010","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Impact of Noninvasive Ventilation Before and After Cardiac Surgery for Preventing Cardiac and Pulmonary Complications: A Clinical Randomized Trial.
Background: The immediate postoperative period after heart surgery poses a substantial risk of life-threatening complications, notably acute pulmonary and cardiac failure. Use of noninvasive ventilation (NIV) may reduce the incidence of pulmonary or heart failure, or both.
Research question: Is the use of NIV before and after cardiac surgery associated with a lower rate of acute pulmonary and heart failure in patients at risk of postoperative complications?
Study design and methods: We designed a prospective, randomized, monocentric trial comparing preoperative and postoperative NIV in cardiac surgery with standard care. Adult patients classified as being at risk of postoperative cardiac or pulmonary failure were allocated to receive NIV for 5 days before and 5 days after surgery in addition to usual care vs usual care alone. The primary outcome was the composite of predefined and adjudicated cardiorespiratory failure at 1 month after cardiac surgery.
Results: Two hundred sixteen patients were included. During the 1-month follow-up period after surgery, the composite outcome occurred in 59 of 107 patients (55.1%) in the NIV group and in 87 of 109 patients (79.8%) in the no NIV group (relative risk, 0.69; 95% CI, 0.57-0.84; P < .001). The benefit persisted at 3 months. No difference between the two groups was found in terms of intubation need and length of hospital stay in cardiac and pulmonary surgery ICUs and in cardiac and pulmonary surgery units.
Interpretation: The use of NIV before and after cardiac surgery reduces the rate of cardiopulmonary failure after high-risk cardiac surgery.
期刊介绍：
At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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