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Cordeiro et al.ǀ Journal of Clinical and Translational Research 2024; 10(6): 334-342 335
with symptomatic myocardial ischemia, particularly when patients with chronic pulmonary disease, physical limitations
one or more coronary arteries are obstructed by atheromatous that compromised functional testing (such as amputations),
plaques [2]. Although patients undergoing CABG often display difficulty understanding the test instructions, the need for
significant results, most of them would develop post-operative surgical reintervention, more than 24 h on invasive MV, and
pulmonary disorders [3]. those who refused to sign the consent form were also excluded.
Approximately 30% of patients undergoing heart surgery The eligibility criteria were assessed by a researcher specifically
experience a decrease in muscle strength and lung function after assigned to this task.
the procedure [4]. Consequently, the emergence of pulmonary
complications can lead to unfavorable clinical outcomes, such as 2.3. Outcomes
atelectasis, pneumonia, pulmonary edema, and acute respiratory The primary outcome was oxygenation and functional
failure, negatively impacting functional recovery [5,6]. Several capacity. Secondary outcomes included the impact on functional
factors, including age, overweight, sex, type of surgery, and variables, such as the Functional Independence Measure (FIM),
intraoperative conditions, can contribute to the development of peripheral muscle strength, pulmonary complications, mortality,
these complications [7]. and length of stay in the ICU and hospital. The primary
Non-invasive ventilation (NIV) can be employed immediately oxygenation outcome was assessed before, immediately after,
after extubation to minimize pulmonary dysfunction, reduce the and one day following the application of NIV. Functional
length of stay in the intensive care unit (ICU), and enhance the capacity was evaluated preoperatively and on the day of hospital
functional capacity of these patients [8-11]. According to the discharge. Likewise, secondary outcomes were also assessed
Brazilian mechanical ventilation (MV) guideline, NIV should preoperatively and on the day of hospital discharge.
be performed immediately after extubation. However, in some
institutions, it is typically implemented on the first post-operative 2.4. Study protocol
day per the institution’s protocol [12]. There is still limited In the pre-operative phase, all patients underwent functional
evidence regarding the validation of clinical and functional
outcomes when comparing NIV administered immediately after assessment using FIM, a 6-min walk test (6MWT), and the
extubation to that performed on the first post-operative day. Medical Research Council (MRC) scale for peripheral muscle
Therefore, this study aims to demonstrate the impact of strength.
administering NIV at different times on patients undergoing The following day, patients were taken to the operating
CABG [12]. While many ICU services routinely use NIV on the room, where the surgery was performed by the same surgical
first post-operative day, we hypothesize that its use immediately team using median sternotomy and cardiopulmonary bypass,
after extubation may increase the likelihood of favorable employing grafts from the internal thoracic artery or bypass. All
outcomes. The purpose of this study was to compare the clinical patients left the operating room with subxiphoid and intercostal
and functional impact of two post-extubation (or prophylactic) drains and were transferred to the ICU with full analgesia.
non-invasive MV protocols for patients undergoing CABG Anesthetic agents included induction with midazolam, propofol,
surgery. or etomidate; analgesia with fentanyl and/or morphine;
neuromuscular blockade with rocuronium, vecuronium, or
2. Methods cisatracurium; and maintenance with isoflurane, transitioning
to an infusion of propofol or dexmedetomidine before transport
2.1. Study design
to the ICU. Intubation was performed using a 7.5- or 8.0-
This was a randomized controlled clinical trial conducted mm internal diameter endotracheal tube. Physiotherapists
with patients admitted to the ICU at the Noble Institute of typically employed a pressure-controlled volume-guaranteed
Cardiology (Instituto Nobre de Cardiologia; INCARDIO) in ventilation mode throughout the study, targeting normocapnia
Feira de Santana, Brazil, from January 2016 to October 2019. or mild hypocapnia while avoiding hypoxemia. Default
The study was approved by the Research Ethics Committee of ventilator settings included a tidal volume (VT) of 500 mL
Noble College (Faculdade Nobre) in Feira de Santana, Brazil and positive end-expiratory pressure (PEEP) of 0 cm H O. All
2
(approval number: 1,405,821). All patients were informed about patients received pain relief with 1 g paracetamol four times
the study’s objectives and provided written informed consent. daily as needed after discharge. On arrival in the ICU, they
The trial was registered in the Brazilian Registry of Clinical were managed according to routine procedures, without any
Trials (ReBEC; trial number RBR-9wkvm5b). influence from the researchers. Following established weaning
criteria, patients were guided toward extubation, after which
2.2. Eligibility criteria
low-flow oxygen support was initiated to maintain saturation
This study included patients of both sexes, aged 18 years or levels at 94 – 97%.
older, who underwent elective CABG with median sternotomy At the hospital where the research was conducted, NIV is
and cardiopulmonary bypass. Patients with hemodynamic routinely performed on the first post-operative day. Shortly after
instability (mean arterial pressure lower than 60 mmHg) extubation, eligible patients were randomized using an electronic
before NIV, those who were uncooperative, or those with system (http://randomizer.org/form.htm) by a professional
contraindications for NIV were excluded. In addition, not part of the research team, ensuring the confidentiality of

DOI: http://doi.org/10.36922/jctr.24.00011