Effectiveness of Assisted Ventilation Supplemented by RTX and NPPV for the Prevention of Postoperative Respiratory Failure in a Patient with Severe COPD Undergoing Total Arch Replacement

(The First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan)

Hitoshi Terada Katsushi Yamashita Naoki Washiyama
Kazuhiro Ohkura Satoshi Akuzawa
A 74-year-old man with very severe chronic obstructive pulmonary disease (COPD) was scheduled for elective total arch replacement for a distal arch saccular aneurysm. Postoperative respiratory failure was anticipated because of a marked reduction in forced expiratory volume in one second (FEV1.0- less than 0.5l ). Through median sternotomy, total arch replacement using selective cerebral perfusion was completed uneventfully. Postoperative respiratory condition was stable. Therefore, the patient was extubated on postoperative day 2 (POD2). However, as the respiratory condition started getting worse, respiratory therapy external (RTX) was introduced to assist ventilation. Additionally, non-invasive positive pressure ventilation (NPPV) with BiPAP was used on POD3 and management with both RTX and NPPV was continued during the remainder of the intensive care unit stay. As a result, we were able to avoid re-intubation. In conclusion, assisted ventilation supplemented by RTX and NPPV was useful for the prevention of postoperative respiratory failure in a patient with very severe COPD undergoing total arch replacement.
@Jpn. J. Cardiovasc. Surg. 37: 112-115 (2008)