BIPAP Vision Versus OPTIFLOW System Comparison in Acute Respiratory Failure After Cardio Thoracic Surgery

Main objective: to determine, if the initiation of OPTIFLOW™ system immediate after cardio/ thoracic surgery with acute respiratory failure or immediate after post extubation in patients at risk, is not less than the start a VNI per BIPAP Vision ®system. In terms of reintubation rates, refusal to continue the technique, or switch to another technique proposed.

Secondary objectives:

• To assess changes in the sensation of dyspnea
• To analyze the skin tolerance and the comfort in this population
• To analyze the evolution of hemodynamic and respiratory parameters
• To compare the number of bronchoscopy performed during the patient's stay in intensive care unit
• Assess the number of postoperative pneumonia and antibiotic consumption
• To determine whether the initiation of any treatment changes in the immediate postoperative length of stay in intensive care and comprehensive.

Inclusion criteria

• Patients after cardiac/thoracic surgery with acute respiratory failure defined by the presence of the following criteria:

• report PaO2/FiO2 <300
• Respiratory rate> 25 for at least 2 hours
• Getting involved accessory respiratory muscles
• paradoxical breathing Or
• In immediate after extubation, the patient will be eligible if present in the withdrawal test:

• SaO2 <90% in 12 L of O2 during a trial of spontaneous ventilation tube on
• PaO2 <10 kPa at a FiO2 ≥ 50% during a VS trial + pressure support
• The presence of a risk factor: Obesity (BMI> 30), FEVG <40%, Failed extubation prior, stridor

Exclusion criteria

• Previous history of SAS
• Patient tracheotomy
• Comas non hypercapnic
• bradypnea
• Cardiac arrest
• Gastric Surgery recent
• Restlessness, lack of cooperation
• Nausea, vomiting
• Hemodynamic instability