Intensive Care Medicine

, Volume 22, Issue 12, pp 1345–1350

Effects of continuous (CPAP) and bi-level positive airway pressure (BiPAP) on extravascular lung water after extubation of the trachea in patients following coronary artery bypass grafting

  • R. Gust
  • H. Schmidt
  • B. W. Böttiger
  • H. Böhrer
  • E. Martin
  • A. Gottcchalk



To evaluate the effects of continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) on extravascular lung water during weaning from mechanical ventilation in patients following coronary artery bypass grafting.


Prospective, randomized clinical study.


Intensive care unit at a university hospital.


Seventy-five patients following coronary artery bypass grafting.


After extubation of the trachea, patients were treated for 30 min with CPAP via face mask (n=25), with nasal BiPAP (n=25), or with oxygen administration via nasal cannula combined with routine chest physiotherapy (RCP) for 10 min (n=25).

Measurements and results

Extravascular lung water (EVLW), pulmonary blood volume index (PBVI) and cardiac index (CI) were obtained during mechanical ventilation (T1), T-piece breathing (T2), interventions (T3), spontaneous breathing 60 min (T4) and 90 min (T5) after extubation of the trachea using a combined dye-thermal dilution method. Changing from mechanical ventilation to T-piece breathing did not show any significant differences in EVLW between the three groups, but a significant increase in PBVI from 155±5 ml/m2 to 170±4 ml/m2 could be observed in all groups (p<0.05). After extubation of the trachea and treatment with BiPAP, PBVI decreased significantly to 134±6 ml/m2 (p<0.05). After treatment with CPAP or BiPAP, EVLW did not change significantly in these groups (5.5±0.3 ml/kg vs 5.0±0.4 ml/kg and 5.1±0.4 ml/kg vs 5.7±0.4 ml/kg). In the RCP-treated group, however, EVLW increased significantly from 5.8±0.3 ml/kg to 7.1±0.4 ml/kg (p<0.05). Sixty and 90 min after extubation, EVLW stayed at a significantly higher level in the RCP-treated group (7.5±0.5 ml/kg and 7.4±0.5 ml/kg) than in the CPAP-(5.6±0.3 ml/kg and 5.9±0.4 ml/kg). No significant differences in CI could be observed within the three groups during the time period from mechanical ventilation to 90 min after extubation of the trachea.


Mask CPAP and nasal BiPAP after extubation of the trachea prevent the increase in extravascular lung water during weaning from mechanical ventilation. This effect is seen for at least 1 h after the discontinuation of CPAP or BiPAP treatment. Fuether studies have to evaluate the clinical relavance of this phenomenon.

Key words

Weaning CPAP BiPAP Extravascular lung water Cardiac surgery 


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  1. 1.
    Wise RA, Robotham JL, Summer WR (1981) Effects of spontaneous ventilation on the circulation. Lung 159: 175–192PubMedGoogle Scholar
  2. 2.
    Lemaire F, Teboul JL, Cinotti G, Abrouk F, Steg G, Macquin-Mavier I, Zapol WM (1988) Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesilogy 69: 171–179Google Scholar
  3. 3.
    Permutt S (1988) Circulatory effects of weaning from mechanical ventilation. The importance of transdiaphragmatic pressure. Anesthesiology 69: 157–160PubMedGoogle Scholar
  4. 4.
    Pinsky MR (1994) Cardiovascular effects of ventilatory support and withdrawal. Anesth Analg 79: 567–576PubMedGoogle Scholar
  5. 5.
    Pinsky MR (1994) Heart-lung interactions during positive-pressure ventilation. Horizoos 2: 443–456Google Scholar
  6. 6.
    Richard C, Teboul JL, Archambaud F, Hebert JL, Michaut P, Auzepy P (1994) Left ventricular function during weaning of patients with chronic obstructive pulmonary disease. Intensives Care Med 20: 181–186Google Scholar
  7. 7.
    Banner MJ, Kirby RR (1994) Attention to heavy breathers, vis-à-vis continuous positive airway pressure. Crit Care Med 22: 1207–1208PubMedGoogle Scholar
  8. 8.
    Mezzanotte WS, Tangel DJ, Fox AM, Ballard RD, White DP (1994) Nocturnal nasal continuous positive airway pressure in patients with chronic obstructive pulmonary disease. Chest 106: 1100–1108PubMedGoogle Scholar
  9. 9.
    Soo Hoo GW, Santiago S, Williams AJ (1994) Nasal mechanical ventilation for hypercapnic respiratory failure in chronic obstructive pulmonary disease: Determinants of success and failure. Crit Care Med 22: 1253–1261PubMedGoogle Scholar
  10. 10.
    Pennock BE, Crawshaw L, Kaplan PD (1994) Noninvasive nasal mask ventilation for acute respiratory failure. Chest 105: 441–444PubMedGoogle Scholar
  11. 11.
    Werner P, Netzer N, Virchow C, Kroegel C, Kortsik C, Matthys H (1994) Nichtinvasive mechanische positive Druckbeatmung bei akutem Atemversagen: Ein Überblick. Intensivmed 31: 199–204Google Scholar
  12. 12.
    Criner GJ, Travaline JM, Brennan KJ, Kreimer DT (1994) Efficacy of a new full face mask for noninvasive positive pressure ventilation. Chest 106: 1109–1115PubMedGoogle Scholar
  13. 13.
    Vianello A, Bevilacqua M, Salvador V, Cardaioli M, Vincenti E (1994) Longterm nasal intermittent positive pressure ventilation in advanced Duchenne's muscular dystrophy. Chest 105: 445–448PubMedGoogle Scholar
  14. 14.
    Renston JP, DiMarco AF, Supinski GS (1994) Respiratory muscle rest using nasal BiPAP ventilation in patients with stable severe COPD. Chest 105: 1053–1060PubMedGoogle Scholar
  15. 15.
    Sen N, Dhanraj (1994) Use of face-mask continuous positive airway pressure (CPAP) in patients with refractory hypoxaemia caused by burn sepsis. Burns 20: 3Google Scholar
  16. 16.
    Pfeiffer UJ, Backus G, Blümel G, Eckart J, Müller P, Winkler P, Zeravik J, Zimmermann GJ (1990) A fiberoptics-based system for integrated monitoring of cardiac output, intrathoracic blood volume, extravascular lung water, O2 saturation and a-v differences. In: Lewis FR, Pfeiffer UJ (eds) Practical applications of fiberoptics in critical care monitoring. Springer, Berlin Heidelberg New York Tokyo, pp 114–125Google Scholar
  17. 17.
    Hacgenberg T, Tenling A, Rothen HU, Nyström SO, Tyden H, Hedenstierna G (1993) Thoracic intravascular and extravascular fluid volumes in cardiac surgical patients. Anesthesiology 79: 976–984PubMedGoogle Scholar
  18. 18.
    Pfeiffer UJ, Wisner-Euteneier AJ, Lichtwarck-Aschoff M, Blümel G (1994) Less invasive monitoring of cardiac performance using arterial thermodilution. Clin Intensive Care 5: S28Google Scholar
  19. 19.
    Pfeiffer UJ, Birk M, Aschenbrenner G, Petrowicz O, Blümel G (1980) Validity of the thermal-dye technique for measurements of extravascular lung water. Eur Surg Res 12: 106–108Google Scholar
  20. 20.
    Lichtwarck-Aschoff M, Zeravik J, Pfeiffer UJ (1992). Intrathoracic blood volume accurately reflects circulatoryy volume status in critically ill patients with mechanical ventilation. Intensive Care Med 18: 142–147PubMedGoogle Scholar
  21. 21.
    Pfeiffer UJ, Lichtwarck-Aschoff M, Beale R (1994) Single thermodilution monitoring of global end-diastolic volume, intrathoracic blood volume extravascular lung water. Clin Intensive Care 5: S38–39Google Scholar
  22. 22.
    Mathru M, Rao TL, El-Etr AA, Pifarre R (1982) Hemodynamic response to changes in ventilatory patterns in patients with normal and poor left ventricular reserve. Crit Care Med 10: 423–426PubMedGoogle Scholar
  23. 23.
    Hurford WE, Lynch KE, Strauss HW, Lowenstein E, Zapol WM (1991) Myocardial perfusion as assessed by thallium-201 scintigraphy during the discontinuation of mechanical ventilation in ventilator-dependent patients. Anesthesiology 74: 1007–1016PubMedGoogle Scholar
  24. 24.
    MacNaughton PD, Braude S, Hunter DN, Denison DM, Evans TW (1992) Changes in lung function and pulmonary capillary permeability after cardiopulmonary bypass. Crit Care Med 20: 1289–1294PubMedGoogle Scholar
  25. 25.
    Stiller K, Montarello J, Wallace M, Daff M, Grant R, Jenkins S, Hall B (1994) Efficacy of breathing and coughing exercises in the prevention of pulmonary complications after coronary artery surgery. Chest 105: 741–747PubMedGoogle Scholar
  26. 26.
    Johnson, D, Kelm C, To T, Hurst T, Naik C, Gulka I, Thomson D, East K, Osaschoff J, Mayers I (1995) Postoperative physical therapy after coronary artery bypass surgery. Am J Respir Crit Care Med 152: 953–958PubMedGoogle Scholar
  27. 27.
    Putensen C, Hörmann C, Baum M, Lingnau W (1993) Comparison of mask and nasal continuous positive airway pressure after extubation and mechanical ventilation. Crit Care Med 21: 357–362PubMedGoogle Scholar
  28. 28.
    Meurice JC, Dore P, Paquereau J, Neau JP, Ingrand P, Chavagnat JJ, Patte F (1994) Predictive factors of long-term compliance with nasal continuous positive airway pressure treatment in sleep apnea syndrome. Chest 105: 429–433PubMedGoogle Scholar
  29. 29.
    Prosise GL, Berry RB (1994) Oral-nasal continuous positive airway pressure as a treatment for obstructive sleep apnea. Chest 106: 180–186PubMedGoogle Scholar
  30. 30.
    Sanders MH, Kern NB, Stiller RA, Strollo PJ, Martin TJ, Atwood CW (1994) CPAP therapy via oronasal mask for obstructive sleep apnea. Chest 106: 774–779PubMedGoogle Scholar
  31. 31.
    Andersen JB, Olesen KP, Eikard B, Jansen E, Quist J (1980) Periodic continuous positive airway pressure, CPAP, by mask in the treatment of atelectasis. Eur J Respir Dis 61: 20–25Google Scholar
  32. 32.
    Pinilla JC, Oleniuk FH, Tan L, Rebeyka I, Tanna N, Wilkinson A, Bharadwaj A (1990) Use of a nasal continuous positive airway pressure mask in the treatment of postoperative atelectasis in aortocoronary bypass surgery. Crit Care Med 18: 836–840PubMedGoogle Scholar
  33. 33.
    Hoeft A, Schorn B, Weyland A, Scholz M, Buhre W, Stephanek E, Allen SJ, Sonntag H (1994) Bedside assessment of intravascular volume status in patients undergoing coronary bypass surgery. Anesthesiology 81: 76–86PubMedGoogle Scholar
  34. 34.
    Kisch H, Leucht S, Lichtwarck-Aschoff M, Pfeiffer UJ (1995) Accuracy and reproducibility of the measurement of actively circulating blood volume with an integrated fiberoptic monitoring system. Crit Care Med 23: 885–893PubMedGoogle Scholar
  35. 35.
    Nawada M, Gotoh K, Yagi Y, Ohshima S, Yamamoto N, Deguchi F, Sawa T, Tanaka H, Yamaguchi M, Uemura H (1993) Extravascular lung water measured with 99mTc-RBC and 99mTTc-DTPA is increased in left-sided heart failure. Ann Nucl Med 7: 87–95PubMedGoogle Scholar
  36. 36.
    Boldt J, Zickman B, Dapper F, Hempelmann G (1991) Does the technique of cardiopulmonary bypass effect lung water content? Eur J Cardiothorac Surg 5: 22–26PubMedGoogle Scholar
  37. 37.
    Nabers J, Hoogsteden HC, Hilvering C (1989) Postpneumonectomy pulmonary edema treated with a continuous positive airway pressure face mask. Crit Care Med 17: 102–103PubMedGoogle Scholar
  38. 38.
    Bersten AD, Holt AW, Vedig AE, Skowronski GA, Baggoley CJ (1991) Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med 26: 325–326Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • R. Gust
    • 1
  • H. Schmidt
    • 1
  • B. W. Böttiger
    • 1
  • H. Böhrer
    • 1
  • E. Martin
    • 1
  • A. Gottcchalk
    • 1
  1. 1.Department of AnaesthesiaUniversity of HeidelbergHeidelbergGermany

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