Postoperative Respiratory Support After Cardiac Surgery: The BREASE ARC International Survey

Objective: To describe current clinician-reported postextubation noninvasive respiratory strategies after cardiac surgery with a focus on variability across centers and emerging combined strategies. Design: Cross-sectional 25-item survey with descriptive analysis. Setting: Cardiac surgery units across Europe, North Africa, the Middle East, and South America. Participants: Ninety-two clinicians from European and French cardiothoracic anesthesia societies; 86% worked in cardiac-dedicated ICUs, 73% had >5 years of experience. Interventions: No clinical interventions were undertaken. Respondents reported institutional protocols and individual postextubation respiratory support practices. Measurements and main results: Institutional protocols were reported by 40% of respondents. Noninvasive respiratory support was used prophylactically by 77% of them, most often in high-risk patients (62%). Obesity (93%), severe chronic obstructive pulmonary disease (FEV1 ≤50%, 93%), and obstructive sleep apnea (78%) were the main risk factors used for stratification. High-flow nasal oxygen (HFNO) and noninvasive ventilation (NIV) were available in almost all units. Combination HFNO-NIV was the most frequently selected prophylactic strategy (37%) and the dominant option for established postextubation respiratory failure (54%). The duration of prophylaxis varied widely, reflecting marked heterogeneity in practice. Decisions were influenced by training and experience (63%), protocol availability, and equipment constraints. Conclusion: Postextubation respiratory practices after cardiac surgery are highly variable, with increasing adoption of combined HFNO-NIV strategies. The absence of standardized pathways contributes to inconsistency in patient selection, timing, and duration. These findings highlight the need for harmonized postoperative respiratory protocols and pragmatic multicenter trials to define optimal respiratory support strategies in cardiac surgical patients.