NIV can be used to prevent acute respiratory failure, treat acute respiratory failure, and avoid re-intubation in post-operative patients.
NIV is used in post-operative patients to achieve two potential goals. The first is to prevent acute respiratory failure whereas the second objective is to treat acute respiratory failure and avoid re-intubation.¹
In an article evaluating NIV post-operatively, it is stated that postoperative hypoxemia and/or acute respiratory failure (ARF) mainly develop after abdominal and/or thoracic surgery. Anesthesia, postoperative pain, and surgery will induce respiratory modification which causes the problem. The clinical result is the product of perioperative-related ventilatory impairment and severity of preoperative pulmonary condition. Therefore, the main objectives for anesthesiologists are to first prevent the occurrence of operative complications, and second to ensure oxygen administration and CO2 removal while avoiding intubation if ARF occurs.¹
In an article in Respitory Care Journal (RCJ) published in 2012, NIV is discussed as a mean to reduce the need for invasive mechanical ventilation and improve clinical outcomes in patients with ARF after lung resection, avoiding the complications related to intubation. It is stated that ARDS remains a lethal complication after major lung resections as the reported mortality rate ranges from 50 to 100 percent, with an increased incidence and mortality rates in pneumonectomy patients. The case reported in the article involved a patient with early acute respiratory distress syndrome (ARDS) after a left-sided pneumonectomy who was successfully treated with NIV.²
Chiumiello et al. reviewed the use of NIV in the perioperative environment where it is mainly used for cardiogenic pulmonary edema, decompensated COPD and hypoxemic pulmonary failure. They concluded that NIV could be considered a prophylactic and therapeutic tool to improve gas exchange in postoperative patients.³