ABSTRACT
Background and Aim: Bilevel positive airway pressure (BIPAP) is emerging as a useful modality in prevention as well as the management of postoperative respiratory dysfunction in patients undergoing coronary artery bypass graft (CABG). Materials and Methods: A total of 50 patients who underwent CABG were managed using BIPAP during postoperative period. Acid-base gas parameters, electrolyte levels, respiratory and hemodynamic parameters, and 24 h urine output before and after BIPAP application were measured. Data were analyzed using SPSS 21.0 version. Paired "t"-test was used to compare the changes in different parameters. Results: The mean age of patients was 57.72 ± 9.67 years (range: 36-85 years), majority were males (84%). Mean body mass index and mean left ventricular ejection fraction of patients were 24.26 ± 3.74 kg.m -2 and 52.77 ± 10.26%, respectively. Mean pO2, pCO2, and respiratory rate before BIPAP application were 90.62 ± 12.90 torr, 40.26 ± 5.39 torr, and 25.64 ± 6.21/min, respectively, which became 158.52 ± 50.43 torr, 37.77 ± 6.98 torr, and 21.78 ± 4.79/min, respectively, after BIPAP application, thus showing a significant change (P < 0.05). No significant change in other parameters was observed. No other adverse effect was noted. Conclusion: BIPAP application helped in improving ventilatory parameters without any adverse impact on hemodynamics and other parameters. Its application was a safe method to prevent respiratory disturbances following cardiac surgery.
ABSTRACT
BACKGROUND: The main documented indication of intrapartum caesarean section is foetal distress (MacKenzie and Cooke in BMJ 323(7318):930, 2001). Foetal distress indicates foetal hypoxia and acidosis during intrauterine life. PURPOSE: To correlate the diagnosis of foetal distress and perinatal outcome. METHODS: This was a prospective observational study of women who underwent caesarean section for foetal distress as detected by cardiotocography and not responding to intrauterine resuscitation. The foetal Apgar score at 1 and 5 min was recorded and cord blood pH was measured in all cases. The neonatal outcome was studied with regard to the need for supportive ventilation and admission to NICU/nursery. RESULTS: In our study, 14.38 % cases diagnosed with foetal distress subsequently had poor outcome. Twenty-one babies had a 5-min Apgar score <7, required immediate resuscitation and were admitted in NICU. Twelve foetuses had a 1-min Apgar score <4, while there were three cases of severe birth asphyxia (Apgar score <4 at 5 min); of these, two babies died. The neonatal outcome was poorer in cases with associated complicating factors. CONCLUSION: The diagnosis of foetal distress is imprecise and a poor predictor of foetal outcome-the result is a tendency for unnecessary caesarean sections. On the contrary, lack of adverse outcome could reflect that our unit makes decisions at a time before clinically significant foetal compromise occurs.
