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Intensive CareCardiovascular Anesthesia
Anaesthesia and surgery induce major changes in respiratory func-tion, in particular when the thorax or the upper abdomen are in-volved. Pulmonary volumes decrease, and atelectasis can develop.Postoperative pain and diaphragm dysfunction further worsen therespiratory function, contributing to the risk of acute respiratoryfailure.Non-invasive ventilation proved to be benecial in the postoperativeperiod, reducing atelectasis, decreasing the work of breathing and -nally improving gas exchange. Both continuous positive airway pres-sure and pressure support were studied with positive results whencorrectly used. Postoperative non-invasive ventilation can be appliedto prevent acute respiratory failure in high-risk patients (elderly,obese, or with pre-existing poor lung or heart function) or to treat it.Cardiac surgery is associated with marked alteration of lung func-tion. So far, few studies evaluated the benets of non-invasive venti- lation after cardiac surgery: all of them took place in intensive careunit in the immediate postoperative phase early after tracheal extu- bation, to prevent acute respiratory failure.Some studies reported positive results on perioperative oxygenation,atelectasis, pulmonary function tests, venous admixture, while oth-er authors found continuous positive airway pressure ineffective onatelectasis, pulmonary function and oxygenation. Despite the con-tradictory results non-invasive ventilation appears a promising toolto prevent acute respiratory failure after cardiac surgery: in the most recent randomized study, Zarbock (Zarbock A, Mueller E, Netzer Set al. Prohylactic nasal continuous positive airway pressure follow-ing cardiac surgery protects from postoperative pulmonary compli-cations. Chest 2009; 135:1252-1259) reported a signicant reduc-tion in pulmonary complication, re-intubation rate and readmissionto the intensive care unit in the non-invasive ventilation group.
t    o    r    a
Non-invasive ventilationafter cardiac surgery
L. Cabrini, A. Zangrillo
 Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy
Corresponding author:
Luca Cabrini, MDDepartment of Anesthesia and Intensive CareUniversità Vita-Salute San Raffaele, Milan, ItalyVia Olgettina, 60 - 20132 Milano, Italye.mail: cabrini.luca@hsr.it 
 HSR Proceedings in Intensive Care and Cardiovascular Anesthesia 2010; 3: XX-XX 
HSR Proceedings in Intensive Care and Cardiovascular Anesthesia 2010, Vol. 2

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