Ventilation non invasive postopératoire : pour qui ? Quand ? Comment ?

Noninvasive ventilation (NIV) aims to apply to levels of positive pressure in airways without tracheal intubation. Knowing that important physiopathological respiratory changes, may occur postoperatively, NIV is used for preventing and thwarting them and especially diaphragmatic dysfunction and the occurrence of atelectasis. The preventive use of NIV achieves the prevention of hypoxemia and/or atelectasis in abdominal, bariatric and cardiac but not in thoracic surgery. For the same surgical procedures, the treament of patient in acute respiratory distress has been documented to avoid reintubation in some patients. The objective is to apply the lowets pressure that improve patient' confort and correct hypoxemia. A single application of Positive End Expiratory Pressure can be used and if necessary inspiratory support can be combined with and increasing level of pressure support titrated to achieve a 6 to 10 mL/kg tidal volume. FiO2 can be titrated to obtain an arterial oxygen saturation higher than 94% in patients with no respiratory comorbidity. The results also depend on the expertise of healthcare providers and the preparation of patients.