OBJECTIVE(S): To evaluate the use of bilevel positive airway pressure (BiPAP) ventilation in early extubation after fast-track cardiac surgery. DESIGN: Prospective observational study. SETTING: Postoperative intensive care. PATIENTS: Sixty consecutive patients eligible for early extubation after cardiac surgery. Patients were predominantly male (42 men (70%)) and middle aged (54.62 +/- 10.66 years). INTERVENTIONS: Patients were randomly assigned to continuous pressure or BiPAP (group I or group II, respectively) and were extubated as soon as possible. MEASUREMENTS: Blood gases and haemodynamics were determined on arrival in the ICU (baseline, or T0) and 1, 2, 4, 6, 8, and 12 hours later. All data were expressed as (+/- SD) and analysed using the Student t-test and Mann-Whitney test (continuous data) or Chi2 test (categorical data). P < 0.05 was considered statistically significant. MAIN RESULTS: PaCO2 levels were statistically significantly higher in group II than in group I at 2, 4, 6, 8, and 12 hours (p < 0.05, p < 0.01). Within each group, PaCO2 levels were statistically significantly higher at 4, 6, 8, and 12 hours than at baseline (p < 0.01). Extubation time was significantly longer in group I than in group II 7.90 (7.90 (2.13) versus 3.83 (1.20), p = 0.001). Respiratory rates were significantly higher in group II than in group I after 2, 4, and 6 hours (p < 0.01). Pmax was higher in group I than in group II after 1 hour but similar up to 4 hours. CONCLUSIONS: Early extubation and weaning to BiPAP ventilation after cardiac surgery is safe and effective.

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