Noninvasive Ventilation using Bipap: Expanding Indications to Post Cardiac Surgery Care

6 In the previous issue of Annals, a single‐center unblinded study assessing the outcomes of noninvasive bilevel positive airway pressure ventilation versus typical positive pressure ventilation through an endotracheal tube for patients with respiratory failure following initial extubation after open heart surgery provides an important reminder that traditional care requires continuous questioning.[1,2] These data also contribute to the emerging literature regarding the use of noninvasive ventilation as an acceptable rescue modality for this specific patient population. Although much data exist showing that bilevel positive airway pressure (BiPAP) is a reasonable option for patients with chronic obstructive pulmonary disease and mild hypercapnia over invasive mechanical ventilation, there are little data using this modality in patients following open heart surgery.[3] Open heart surgery remains one of the most common indications for mechanical ventilation throughout the world. Safer, noninvasive modalities to treat patients who fall off the “pathways” for spontaneous breathing and extubation in this population are important because of the large number of patients impacted and the known complications of invasive mechanical ventilation through an endotracheal tube.