Biphasic positive airway pressure ventilation [BIPAP] versus synchronized intermittent mandatory ventilation with pressure support [SIMV/PSV] after pediatric open heart surgery

ABSTRACT

Biphasic positive airway pressure [BIPAP] is a mode of ventilation, which allows unrestricted spontaneous breathing at any moment of the ventilatory cycle. Following open-heart surgery in adults, this mode of ventilation [BIPAP] is being accepted with a decrease in the need for sedation and a shorter time of intubation. In this study we compared BIPAP versus synchronized intermittent mandatory ventilation with pressure support [SIMV/PSV] following open-heart surgery in children for simple congenital cardiac anomalies. Twenty-four children aged 4-12 year undergoing repair of simple congenital cardiac anomalies, were randomly classified postoperatively into two equal groups. Group I ventilated by BIPAP mode of ventilation and Group II ventilated by SIMV/PSV mode of ventilation. Evita 4 ventilator was used in this study. Midazolam and morphine were used and adjusted according to comfort scale. In this study we compared between BIPAP and SIMV/PSV as regards hemodynamic data, ventilatory parameters, the needs for sedation and analgesia and the mean duration of endotracheal intubation. The two groups were comparable as regards the demographic data. There were significant differences between the two groups regarding better hemodynamic stability, increased comfort scale, and decreased the needs for sedation and analgesia in group I when compared to group II The ventilatory parameters were significantly better in-group I with better minute ventilation, lower PaCO[2] and higher PaO[2] when compared to group II. The mean duration of endotracheal intubation was significantly shorter in-group I when compared to group II. BIPAP is an effective, safe and easy to use mode of ventilation in children following open-heart surgery for simple congenital anomalies. Further assessment needed for its use in more complicated cases