NEW YORK (Reuters Health) – The prophylactic use of nasal continuous positive airway pressure (nCPAP) can help prevent pneumonia and other pulmonary complications after cardiac surgery, according to a study in the May issue of Chest.

The results also show that prophylactic use of nCPAP can significantly reduce readmission rates to intensive and intermediate care units.

Dr. Alexander Zarbock, from the University of Muenster, Germany, and colleagues assessed the benefits of prophylactic nCPAP in this setting by randomly assigning 500 patients scheduled for elective cardiac surgery to receive uninterrupted nCPAP for at least 6 hours or standard therapy, which includes nCPAP but only at 10-minute intervals every 4 hours. All of the subjects were considered standard-risk patients and were undergoing elective cardiac surgery.

Both interventions began postoperatively after extubation in either the operating room or intensive care unit. The nCPAP pressure was set at 10 cm H2O, the report indicates.

Relative to standard therapy, prophylactic nCPAP significantly enhanced arterial oxygenation without altering the heart rate or mean arterial blood pressure, the researchers found.

Fewer patients in the prophylactic nCPAP group than in the control group experienced pulmonary complications, including hypoxemia, pneumonia, and reintubation: 12 of 232 vs. 25 of 236 (p = 0.03), respectively. Consistent with this finding, patients in the intervention group were less likely than the controls to require readmission to the intensive or intermediate care units: 7 of 232 vs. 14 of 236 (p = 0.03).

As well as being effective in improving outcomes after cardiac surgery, prophylactic nCPAP therapy “is a well-tolerated, simple and inexpensive technique,” the authors emphasize.

Further research, they add, is needed to evaluate the use of prophylactic nCPAP in high-risk patients, although it might be expected that the benefits would be even more pronounced.

Reference:
Chest 2009;135:1252-1259.