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Imperatore F, Gritti F, Esposito R, del Giudice C, Cafora C, Pennacchio F, Maglione F, Catauro A, Pace MC, Docimo L, Gambardella C. Non-Invasive Ventilation Reduces Postoperative Respiratory Failure in Patients Undergoing Bariatric Surgery: A Retrospective Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1457. [PMID: 37629747 PMCID: PMC10456476 DOI: 10.3390/medicina59081457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Postoperative non-invasive ventilation (NIV) has been proposed as an attractive strategy to reduce morbidity in obese subjects undergoing general anaesthesia. The increased body mass index (BMI) correlates with loss of perioperative functional residual capacity, expiratory reserve volume, and total lung capacity. The aim of the current study is to evaluate the efficacy of NIV in a post-anaesthesia care unit (PACU) in reducing post-extubation acute respiratory failure (ARF) after biliointestinal bypass (BIBP) in obese patients. Materials and Methods: A retrospective analysis was conducted from January 2019 to December 2020 to compare acute respiratory failure within the first 72 postoperative hours and oximetry values of obese patients who underwent BIBP after postoperative NIV adoption or conventional Venturi mask. Results: In total, 50 patients who received NIV postoperative protocol and 57 patients who received conventional Venturi mask ventilation were included in the study. After 120 min in PACU pH, pCO2, pO2, and SpO2 were better in the NIV group vs. control group (p < 0.001). Seventy-two hours postoperatively, one patient (2%) in the NIV group vs. seven patients (12.2%) in the control group developed acute respiratory failure. Therefore, conventional Venturi mask ventilation resulted in being significantly associated (p < 0.05) with postoperative ARF with an RR of 0.51 (IC 0.27-0.96). Conclusions: After bariatric surgery, short-term NIV during PACU observation promotes a more rapid recovery of postoperative lung function and oxygenation in obese patients, reducing the necessity for critical care in the days following surgery. Therefore, as day-case surgery becomes more advocated even for morbid obesity, it might be considered a necessary procedure.
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Affiliation(s)
- Francesco Imperatore
- Unit of Anaesthesia and Intensive Care, “San Giovanni di Dio Hospital” Frattamaggiore, 80020 Naples, Italy
| | - Fabrizio Gritti
- Unit of Intensive Care, Department of Emergency, “A. Cardarelli Hospital”, 80131 Naples, Italy; (F.G.); (R.E.); (C.C.)
- Unit of Anaesthesia and Intensive Care, University of Campania “L. Vanvitelli”, 80131 Naples, Italy;
| | - Rossella Esposito
- Unit of Intensive Care, Department of Emergency, “A. Cardarelli Hospital”, 80131 Naples, Italy; (F.G.); (R.E.); (C.C.)
- Unit of Anaesthesia and Intensive Care, University of Campania “L. Vanvitelli”, 80131 Naples, Italy;
| | - Claudia del Giudice
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
| | - Chiara Cafora
- Unit of Intensive Care, Department of Emergency, “A. Cardarelli Hospital”, 80131 Naples, Italy; (F.G.); (R.E.); (C.C.)
- Unit of Anaesthesia and Intensive Care, University of Campania “L. Vanvitelli”, 80131 Naples, Italy;
| | - Francesco Pennacchio
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
| | - Francesco Maglione
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
| | - Antonio Catauro
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
| | - Maria Caterina Pace
- Unit of Anaesthesia and Intensive Care, University of Campania “L. Vanvitelli”, 80131 Naples, Italy;
| | - Ludovico Docimo
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
| | - Claudio Gambardella
- Division of General, Mininvasive, Oncologic and Bariatric Surgery, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (C.d.G.); (F.P.); (F.M.); (A.C.); (L.D.)
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Osterkamp JTF, Strandby RB, Henningsen L, Marcussen KV, Thomsen T, Mortensen CR, Achiam MP, Jans Ø. Comparing the effects of continuous positive airway pressure via mask or helmet interface on oxygenation and pulmonary complications after major abdominal surgery: a randomized trial. J Clin Monit Comput 2023; 37:63-70. [PMID: 35429325 PMCID: PMC9013185 DOI: 10.1007/s10877-022-00857-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/29/2022] [Indexed: 01/25/2023]
Abstract
The risk of pulmonary complications is high after major abdominal surgery but may be reduced by prophylactic postoperative noninvasive ventilation using continuous positive airway pressure (CPAP). This study compared the effects of intermittent mask CPAP (ICPAP) and continuous helmet CPAP (HCPAP) on oxygenation and the risk of pulmonary complications following major abdominal surgery. Patients undergoing open abdominal aortic aneurysm repair or pancreaticoduodenectomy were randomized (1:1) to either postoperative ICPAP or HCPAP. Oxygenation was evaluated as the partial pressure of oxygen in arterial blood fraction of inspired oxygen ratio (PaO2/FIO2) at 6 h, 12 h, and 18 h postoperatively. Pulmonary complications were defined as X-ray verified pneumonia/atelectasis, clinical signs of pneumonia, or supplementary oxygen beyond postoperative day 3. Patient-reported comfort during CPAP treatment was also evaluated. In total, 96 patients (ICPAP, n = 48; HCPAP, n = 48) were included, and the type of surgical procedure were evenly distributed between the groups. Oxygenation did not differ between the groups by 6 h, 12 h, or 18 h postoperatively (p = 0.1, 0.08, and 0.67, respectively). Nor was there any difference in X-ray verified pneumonia/atelectasis (p = 0.40) or supplementary oxygen beyond postoperative day 3 (p = 0.53). Clinical signs of pneumonia tended to be more frequent in the ICPAP group (p = 0.06), yet the difference was not statistically significant. Comfort scores were similar in both groups (p = 0.43), although a sensation of claustrophobia during treatment was only experienced in the HCPAP group (11% vs. 0%, p = 0.03). Compared with ICPAP, using HCPAP was associated with similar oxygenation (i.e., PaO2/FIO2 ratio) and a similar risk of pulmonary complications. However, HCPAP treatment was associated with a higher sensation of claustrophobia.
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Affiliation(s)
- Jens T F Osterkamp
- Department of Surgical Gastroenterology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Rune B Strandby
- Department of Surgical Gastroenterology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lara Henningsen
- Department of Anaesthesia, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Klaus V Marcussen
- Department of Anaesthesia and Intensive Care, Slagelse Hospital, University of Zeeland, Slagelse, Denmark
| | - Thordis Thomsen
- Department of Clinical Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian R Mortensen
- Department of Anaesthesia, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michael P Achiam
- Department of Surgical Gastroenterology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Øivind Jans
- Department of Anaesthesia, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Gharib A. Effect of continuous positive airway pressure on the respiratory system: a comprehensive review. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2023. [DOI: 10.1186/s43168-022-00175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Abstract
Background
CPAP is characterized by the application of a constant and continuous positive pressure into the patient’s airway. By delivering a constant pressure during both inspiration and expiration, CPAP increases functional residual capacity and opens collapsed or under ventilated alveoli, thus decreasing right to left intrapulmonary shunt and improving oxygenation in obese individuals.
Main body of abstract
Obesity is characterized by several alterations in the mechanics of the respiratory system that tend to further exaggerate impairment of gas exchange rendering these patients prone to perioperative complications, such as hypoxemia, hypercapnia, and atelectasis. Interestingly, CPAP has been advocated as an efficacious modality for prevention and treatment of postoperative atelectasis considered to be the most common postoperative respiratory complication. In OSA, the CPAP device works to splint the airway open and prevent the collapse of the upper airway that is the cardinal event of OSA leading improvement of sleep, quality of life and the reduction of the risks of the cardiovascular and neurocognitive side effects associated with the disease. Besides such a beneficial effect, there are other physiological benefits to CPAP: greater end-expiratory lung volume and consequent increase in oxygen stores, increased tracheal traction to improve upper airway patency and decrease in cardiac after load.
Conclusion
Due to various physiological benefits on the respiratory system CPAP therapy is crucial for the prevention postoperative complications particularly related to obesity and the cornerstone for the treatment of moderate to severe obstructive sleep apnea.
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Prophylactic Postoperative Noninvasive Ventilation in Adults Undergoing Upper Abdominal Surgery: A Systematic Review and Meta-Analysis. Crit Care Med 2022; 50:1522-1532. [PMID: 35881511 DOI: 10.1097/ccm.0000000000005628] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Postoperative pulmonary complications (PPCs) are a leading cause of morbidity and mortality following upper abdominal surgery. Applying either noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP) in the early postoperative period is suggested to prevent PPC. We aimed to assess whether postoperative NIV or CPAP or both prevent PPCs compared with standard care in adults undergoing upper abdominal surgery, including in those identified at higher PPC risk. Additionally, the different interventions used were evaluated to assess whether there is a superior approach. DATA SOURCES We searched PubMed, Embase' CINAHL, CENTRAL, and Scopus from inception to May 17, 2021. STUDY SELECTION We performed a systematic search of the literature for randomized controlled trials evaluating prophylactic NIV and/or CPAP in the postoperative period. DATA EXTRACTION Two authors independently performed study selection and data extraction. Individual study risk of bias was assessed using the PEDro scale, and certainty in outcomes was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. DATA SYNTHESIS We included 17 studies enrolling 6,108 patients. No significant benefit was demonstrated for postoperative NIV/CPAP to reduce PPC (risk ratio [RR], 0.89; 95% CI, 0.78-1.01; very low certainty), including in adults identified at higher PPC risk (RR, 0.91; 95% CI, 0.77-1.07; very low certainty). No intervention approach was identified as superior, and no significant benefit was demonstrated when comparing: 1) CPAP (RR, 0.90; 95% CI, 0.79-1.04; very low certainty), 2) NIV (RR, 0.68; 95% CI, 0.41-1.13; very low certainty), 3) continuous NIV/CPAP (RR, 0.90; 95% CI, 0.77-1.05; very low certainty), or 4) intermittent NIV/CPAP (RR, 0.66; 95% CI, 0.39-1.10; very low certainty) to standard care. CONCLUSIONS These findings suggest routine provision of either prophylactic NIV or CPAP following upper abdominal surgery may not be effective to reduce PPCs' including in those identified at higher risk.
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Hui S, Fowler AJ, Cashmore RMJ, Fisher TJ, Schlautmann J, Body S, Lan-Pak-Kee V, Webb M, Kyriakides M, Ng JY, Chisvo NS, Pearse RM, Abbott TEF. Routine postoperative noninvasive respiratory support and pneumonia after elective surgery: a systematic review and meta-analysis of randomised trials. Br J Anaesth 2021; 128:363-374. [PMID: 34916050 DOI: 10.1016/j.bja.2021.10.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Postoperative pulmonary complications, including pneumonia, are a substantial cause of morbidity. We hypothesised that routine noninvasive respiratory support was associated with a lower incidence of pneumonia after surgery. METHODS Systematic review and meta-analysis of RCTs comparing the routine use of continuous positive airway pressure (CPAP), noninvasive ventilation (NIV), or high-flow nasal oxygen (HFNO) against standard postoperative care in the adult population. We searched MEDLINE (PubMed), EMBASE, and CENTRAL from the start of indexing to July 27, 2021. Articles were reviewed and data extracted in duplicate, with discrepancies resolved by a senior investigator. The primary outcome was pneumonia, and the secondary outcome was postoperative pulmonary complications. We calculated risk difference (RD) with 95% confidence intervals using DerSimonian and Laird random effects models. We assessed risk of bias using the Cochrane risk of bias tool. RESULTS From 18 513 records, we included 38 trials consisting of 9782 patients. Pneumonia occurred in 214/4403 (4.9%) patients receiving noninvasive respiratory support compared with 216/3937 (5.5%) receiving standard care (RD -0.01 [95% confidence interval: -0.02 to 0.00]; I2=8%; P=0.23). Postoperative pulmonary complications occurred in 393/1379 (28%) patients receiving noninvasive respiratory support compared with 280/902 (31%) receiving standard care (RD -0.11 [-0.23 to 0.01]; I2=79%; P=0.07). Subgroup analyses did not identify a benefit of CPAP, NIV, or HFNO in preventing pneumonia. Tests for publication bias suggest six unreported trials. CONCLUSION The results of this evidence synthesis do not support the routine use of postoperative CPAP, NIV, or HFNO to prevent pneumonia after surgery in adults. CLINICAL TRIAL REGISTRATION PROSPERO: CRD42019156741.
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Affiliation(s)
- Sara Hui
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alexander J Fowler
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Richard M J Cashmore
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Thomas J Fisher
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jonas Schlautmann
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | - Maylan Webb
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Jing Yong Ng
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nathan S Chisvo
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rupert M Pearse
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tom E F Abbott
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Pelaia C, Bruni A, Garofalo E, Rovida S, Arrighi E, Cammarota G, Navalesi P, Pelaia G, Longhini F. Oxygenation strategies during flexible bronchoscopy: a review of the literature. Respir Res 2021; 22:253. [PMID: 34563179 PMCID: PMC8464093 DOI: 10.1186/s12931-021-01846-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/18/2021] [Indexed: 12/14/2022] Open
Abstract
During flexible fiberoptic bronchoscopy (FOB) the arterial partial pressure of oxygen can drop, increasing the risk for respiratory failure. To avoid desaturation episodes during the procedure several oxygenation strategies have been proposed, including conventional oxygen therapy (COT), high flow nasal cannula (HFNC), continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV). By a review of the current literature, we merely describe the clinical practice of oxygen therapies during FOB. We also conducted a pooled data analysis with respect to oxygenation outcomes, comparing HFNC with COT and NIV, separately. COT showed its benefits in patients undergoing FOB for broncho-alveolar lavage (BAL) or brushing for cytology, in those with peripheral arterial oxyhemoglobin saturation < 93% prior to the procedure or affected by obstructive disorder. HFNC is preferable over COT in patients with mild to moderate acute respiratory failure (ARF) undergoing FOB, by improving oxygen saturation and decreasing the episodes of desaturation. On the opposite, CPAP and NIV guarantee improved oxygenation outcomes as compared to HFNC, and they should be preferred in patients with more severe hypoxemic ARF during FOB.
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Affiliation(s)
- Corrado Pelaia
- Pulmonary Medicine Unit, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, "Mater Domini" University Hospital, "Magna Graecia" University, Viale Europa, 88100, Catanzaro, Italy
| | - Eugenio Garofalo
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, "Mater Domini" University Hospital, "Magna Graecia" University, Viale Europa, 88100, Catanzaro, Italy
| | - Serena Rovida
- Department of Emergency Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Eugenio Arrighi
- Pulmonary Medicine Unit, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Gianmaria Cammarota
- Anesthesia and General Intensive Care, "Maggiore Della Carità" University Hospital, Novara, Italy
| | - Paolo Navalesi
- Department of Medicine-DIMED, Anesthesia and Intensive Care, Padua Hospital, University of Padua, Padua, Italy
| | - Girolamo Pelaia
- Pulmonary Medicine Unit, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, "Mater Domini" University Hospital, "Magna Graecia" University, Viale Europa, 88100, Catanzaro, Italy.
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Di Bella C, Araos J, Lacitignola L, Grasso S, De Marzo L, Crovace AM, Staffieri F. Effects of continuous positive airway pressure administered by a helmet in cats under general anaesthesia. J Feline Med Surg 2021; 23:337-343. [PMID: 32840420 PMCID: PMC10812219 DOI: 10.1177/1098612x20951279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the respiratory effects of non-invasive continuous positive airway pressure (CPAP) administered by a helmet in healthy cats under anaesthesia. METHODS Fifteen healthy male cats scheduled for castration were anaesthetised with medetomidine (20 µg/kg), ketamine (10 mg/kg) and buprenorphine (20 µg/kg) intramuscularly. When an adequate level of anaesthesia was achieved, a paediatric helmet was placed on all subjects. The helmet was connected to a Venturi valve supplied with medical air and cats received the following phases of treatments: 0 cmH2O (pre-CPAP), 5 cmH2O (CPAP) and 0 cmH2O (post-CPAP). Each treatment lasted 10 mins. At the end of each phase an arterial blood sample was drawn. The following data were also collected: mean arterial pressure, respiratory rate, heart rate and the anaesthesia level score (0 = awake, 10 = deep anaesthesia). The alveolar to arterial oxygen gradient (P[A-a]O2) and the venous admixture (Fshunt) were also estimated. Data were analysed with two-way ANOVA (P <0.05). RESULTS The arterial partial pressure of oxygen was higher (P <0.001) at CPAP (103.2 ± 5.1 mmHg) vs pre-CPAP (77.5 ± 7.4 mmHg) and post-CPAP (84.6 ± 8.1 mmHg). The P(A-a)O2 and the Fshunt were lower (P <0.001) at CPAP (4.4 ± 2.3 mmHg; 7.4 ± 3.1%) vs pre-CPAP (18.9 ± 6.4 mmHg; 22.8 ± 4.6%) and post-CPAP (15.6 ± 7.3 mmHg; 20.9 ± 4.6 %). No other parameters differed between groups. CONCLUSIONS AND RELEVANCE Non-invasive CPAP applied by a helmet improves oxygenation in cats under injectable general anaesthesia.
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Affiliation(s)
- Caterina Di Bella
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Valenzano, Bari, Italy
| | - Joaquin Araos
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | - Luca Lacitignola
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Valenzano, Bari, Italy
| | - Salvatore Grasso
- Section of Anaesthesia and Intensive Care, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Linda De Marzo
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Valenzano, Bari, Italy
| | - Alberto Maria Crovace
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Valenzano, Bari, Italy
| | - Francesco Staffieri
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organs Transplantation, University of Bari ‘Aldo Moro’, Valenzano, Bari, Italy
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Mutti C, Azzi N, Soglia M, Pollara I, Alessandrini F, Parrino L. Obstructive sleep apnea, cpap and COVID-19: a brief review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020196. [PMID: 33525235 PMCID: PMC7927548 DOI: 10.23750/abm.v91i4.10941] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea (OSA) is a broadly diffused curable chronic low-grade inflammatory disease sharing impressive clinical and pathogenetic features with Covid-19. Moreover, a potential role of OSA as a detrimental factor for Covid-19 severity has been hypothesized. Continuous positive airway pressure (CPAP) is the mainstay treatment for moderate-severe OSA, but the beneficial effects of ventilation strongly depend on medical expertise and on the patient's adherence and compliance. Although several papers have analyzed the overlaps and outcomes of OSA and Covid-19, limited attention has been dedicated to ventilatory adherence and management of OSA cohorts exposed to Covid-19. We briefly review the literature data, pointing out the main risks and benefits of CPAP for OSA patients in the pandemic setting.
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Affiliation(s)
| | - Nicoletta Azzi
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Margherita Soglia
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Irene Pollara
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Francesca Alessandrini
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Liborio Parrino
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Parma, Italy.
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Ball L, Almondo C, Pelosi P. Perioperative Lung Protection: General Mechanisms and Protective Approaches. Anesth Analg 2020; 131:1789-1798. [DOI: 10.1213/ane.0000000000005246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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10
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Lee JH, Ji SH, Jang YE, Kim EH, Kim JT, Kim HS. Application of a High-Flow Nasal Cannula for Prevention of Postextubation Atelectasis in Children Undergoing Surgery: A Randomized Controlled Trial. Anesth Analg 2020; 133:474-482. [PMID: 33181560 DOI: 10.1213/ane.0000000000005285] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND General anesthesia-induced atelectasis is common, and persistent postoperative atelectasis is associated with pulmonary complications. We aimed to evaluate the preventive effects of a high-flow nasal cannula (HFNC) on postoperative atelectasis and respiratory complications in infants and small children. METHODS In this prospective randomized controlled trial, children (≤2 years) receiving general anesthesia (>2 hours) were randomized into the control and HFNC groups. At the end of the surgery, the first lung ultrasound evaluation was performed in both groups. In the postanesthetic care unit (PACU), the control group received conventional oxygen therapy, while the HFNC group received oxygen via HFNC, with a flow rate of 2 L kg-1 min-1. Before discharge to the ward, a second lung ultrasound examination was performed. The primary outcome was the lung ultrasound score at PACU discharge. The secondary outcomes included the lung ultrasound score at the end of surgery, the incidence of significant atelectasis at PACU discharge, and other postoperative outcomes. RESULTS Lung ultrasound score and the incidence of atelectasis at the end of surgery did not differ significantly between the control (n = 38) and HFNC (n = 40) groups. After staying in the PACU, both groups showed a reduced lung ultrasound score and atelectasis incidence. However, the HFNC group had a significantly lower consolidation score than the control group (0; interquartile range [IQR] = 0-1 vs 3; IQR = 2-4; P< .001). Additionally, none of the patients had significant atelectasis in the HFNC group, compared to 6 patients in the control group (0% vs 15.8%; odds ratio [OR] = 0.444; 95% confidence interval for OR, 0.343-0.575; P = .011). Incidence of desaturation (oxygen saturation [Spo2] ≤ 95%), postoperative complications, and the length of hospital stay did not differ between the groups. CONCLUSIONS Preventive use of HFNC after surgery improves the lung ultrasound score and reduces postoperative atelectasis compared to conventional oxygen therapy in infants and small children.
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Affiliation(s)
- Ji-Hyun Lee
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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11
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Longhini F, Bruni A, Garofalo E, Navalesi P, Grasselli G, Cosentini R, Foti G, Mattei A, Ippolito M, Accurso G, Vitale F, Cortegiani A, Gregoretti C. Helmet continuous positive airway pressure and prone positioning: A proposal for an early management of COVID-19 patients. Pulmonology 2020; 26:186-191. [PMID: 32386886 PMCID: PMC7190517 DOI: 10.1016/j.pulmoe.2020.04.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 02/08/2023] Open
Affiliation(s)
- F Longhini
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
| | - A Bruni
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - E Garofalo
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - P Navalesi
- Anesthesia and Intensive Care, Padua Hospital, Department of Medicine - DIMED, University of Padua, Italy
| | - G Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Italy; Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - R Cosentini
- Emergency Medicine Department, ASST Papa Giovanni XIII, Bergamo, Italy
| | - G Foti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy
| | - A Mattei
- Department of Pneumology, A.O.U. Città della Salute e della Scienza of Turin, Turin, Italy
| | - M Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Italy
| | - G Accurso
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Italy
| | - F Vitale
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Italy
| | - A Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Italy
| | - C Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Italy
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Bjorklund AR, Mpora BO, Steiner ME, Fischer G, Davey CS, Slusher TM. Use of a modified bubble continuous positive airway pressure (bCPAP) device for children in respiratory distress in low- and middle-income countries: a safety study. Paediatr Int Child Health 2019; 39:160-167. [PMID: 29912645 PMCID: PMC6858283 DOI: 10.1080/20469047.2018.1474698] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: While bubble continuous positive airway pressure (bCPAP) is commonly used in low- and middle-income countries (LMIC) to support neonates with respiratory distress, there are limited non-invasive support options for non-neonatal children. Aim: To demonstrate safety of a new device designed to support children during respiratory distress in LMIC. Methods: A paediatric bCPAP device was designed called SEAL-bCPAP (Simplified Ear-plug Adapted-bCPAP). SEAL-bCPAP is constructed from inexpensive, easily obtainable materials. The nasal prong interface was modified from previously described neonatal bCPAP set-ups using commercial ear-plug material to improve nasal seal. A prospective interventional study was conducted to evaluate safety in children with respiratory distress treated with SEAL-bCPAP. Patients aged 30 days to 5 years presenting to a hospital in northern Uganda from July 2015 to June 2016 were screened. Those with moderate-severe respiratory distress and/or hypoxia despite nasal cannula oxygen were eligible for study. Enrolled patients were supported with SEAL-bCPAP until respiratory improvement or death. Complications attributable to SEAL-bCPAP were recorded. Clinical outcomes were compared with historical control pre-trial data. Results: Eighty-three of 87 enrolled patients were included in the final analysis. No patients had significant SEAL-bCPAP complications. Five patients had mild complications which resolved (four with nasal irritation and one with abdominal distention). Trial patients had significant (p < 0.0001) improvement in their TAL score, respiratory rate and O2sat after 2 h of SEAL-bCPAP. Fifty-two of 64 patients (62.7%) with severe illness at Time1 did not have severe illness at Time2 (after 2 h of SEAL-bCPAP) (p < 0.0001). Unadjusted mortality rates were 12.2% (6/49) and 9.6% (8/83), respectively, for pre-trial (historical control) and trial patients (p = 0.64); the study was not powered to show efficacy. Conclusions: The SEAL-bCPAP device is safe for treatment of respiratory distress in non-neonatal children in LMIC. There is a trend toward decreased mortality that should be evaluated with adequately powered clinical trials.
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Key Words
- ACU, acute care unit
- BUBBLES, bCPAP used beyond babies in low economic settings
- Bubble continuous positive airway pressure
- CPAP, continuous positive airway pressure
- LMIC, low- and middle-income countries
- OR, odds ratio
- Osat, oxygen saturation
- RR, respiratory rate
- SD, standard deviation
- SEAL-bCPAP, simplified ear-plug adapted low-cost bCPAP
- TAL score, modified TAL clinical score
- bCPAP, bubble continuous positive airway pressure
- child health
- cmHO, cm of water
- device innovations
- global health
- international health
- low- and middle-income countries
- respiratory support
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Affiliation(s)
- Ashley R. Bjorklund
- Division of Pediatric critical care, University of Minnesota, Minneapolis, MD, USA,Department of Pediatrics, Walter Reed National Military Medical center, Bethesda, MD
| | | | - Marie E. Steiner
- Division of Pediatric critical care, University of Minnesota, Minneapolis, MD, USA
| | - Gwenyth Fischer
- Division of Pediatric critical care, University of Minnesota, Minneapolis, MD, USA
| | - Cynthia S. Davey
- Biostatistical design and analysis center, University of Minnesota, Minneapolis, MN, USA
| | - Tina M. Slusher
- Center for Global Pediatrics, University of Minnesota, Minneapolis, MN, USA,Department of Pediatrics, hennepin county Medical center, Minneapolis, MN, USA
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Lockstone J, Boden I, Robertson IK, Story D, Denehy L, Parry SM. Non-Invasive Positive airway Pressure thErapy to Reduce Postoperative Lung complications following Upper abdominal Surgery (NIPPER PLUS): protocol for a single-centre, pilot, randomised controlled trial. BMJ Open 2019; 9:e023139. [PMID: 30782696 PMCID: PMC6340066 DOI: 10.1136/bmjopen-2018-023139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 08/18/2018] [Accepted: 11/23/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Postoperative pulmonary complications (PPCs) are a common serious complication following upper abdominal surgery leading to significant consequences including increased mortality, hospital costs and prolonged hospitalisation. The primary objective of this study is to detect whether there is a possible signal towards PPC reduction with the use of additional intermittent non-invasive ventilation (NIV) compared with continuous high-flow nasal oxygen therapy alone following high-risk elective upper abdominal surgery. Secondary objectives are to measure feasibility of: (1) trial conduct and design and (2) physiotherapy-led NIV and a high-flow nasal oxygen therapy protocol, safety of NIV and to provide preliminary costs of care information of NIV and high-flow nasal oxygen therapy. METHODS AND ANALYSIS This is a single-centre, parallel group, assessor blinded, pilot, randomised trial, with 130 high-risk upper abdominal surgery patients randomly assigned via concealed allocation to either (1) usual care of continuous high-flow nasal oxygen therapy for 48 hours following extubation or (2) usual care plus five additional 30 min physiotherapy-led NIV sessions within the first two postoperative days. Both groups receive standardised preoperative physiotherapy and postoperative early ambulation. No additional respiratory physiotherapy is provided to either group. Outcome measures will assess incidence of PPC within the first 14 postoperative days, recruitment ability, physiotherapy-led NIV and high-flow nasal oxygen therapy protocol adherence, adverse events relating to NIV delivery and costs of providing a physiotherapy-led NIV and a high-flow nasal oxygen therapy service following upper abdominal surgery. ETHICS AND DISSEMINATION Ethics approval has been obtained from the relevant institution and results will be published to inform future multicentre trials. TRIAL REGISTRATION NUMBER ACTRN12617000269336; Pre-results.
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Affiliation(s)
- Jane Lockstone
- Department of Physiotherapy, Launceston General Hospital, Launceston, Tasmania, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ianthe Boden
- Department of Physiotherapy, Launceston General Hospital, Launceston, Tasmania, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Iain K Robertson
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - David Story
- Anaesthesia Perioperative and Pain Medicine Unit, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Selina M Parry
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
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Thanthitaweewat V, Muntham D, Chirakalwasan N. Targeted-Volume Noninvasive Ventilation Reduces Extubation Failure in Postextubated Medical Intensive Care Unit Patients: A Randomized Controlled Trial. Indian J Crit Care Med 2018; 22:639-645. [PMID: 30294129 PMCID: PMC6161579 DOI: 10.4103/ijccm.ijccm_236_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Till date, the benefit of using noninvasive ventilation (NIV) routinely after extubation to prevent reintubation has been conflicting. We aim to demonstrate the effect of targeted-volume NIV for the prevention of reintubation and extubation failure after planned extubation in medical intensive care unit (ICU) patients. Study Design This was a prospective, randomized controlled study. Materials and Methods Patients on invasive mechanical ventilation for more than 48 hrs for acute respiratory failure, who were ready for extubation, were randomized into targeted-volume NIV (intervention group) or oxygen mask (controlled group) immediately after extubation and continuously for 24 hrs. Results A total of 58 patients were enrolled in this study. The targeted-volume NIV group was observed to have a trend toward lower reintubation rate within 48 hrs compared to oxygen mask group (0% vs. 17.2%; P = 0.052). Extubation failure rate within 48 hrs was significantly lower in targeted-volume NIV group compared to oxygen mask group (0% vs. 41.38%; P < 0.001). There was a trend toward lower ICU length of stay (6[5] days vs. 10[8] days (median interquartile range [IQR]); P = 0.053) as well as shorter hospital length of stay after extubation (10[19] days vs. 18[15] days (median [IQR]); P = 0.059). There were no differences in the incidence of ventilator-associated pneumonia (VAP)/hospital-acquired pneumonia (HAP) (6.90% vs. 20.69%;P = 0.253) and 28 day-mortality (13.79% vs. 20.69%; P = 0.487). Conclusions Our study is the first study to demonstrate the benefit of application of targeted-volume NIV immediately after extubation in reducing extubation failure rate. There was a trend toward lowering reintubation rate and shorter ICU length of stay and hospital length of stay after extubation in mixed medical ICU patients.
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Affiliation(s)
- Vorawut Thanthitaweewat
- Department of Medicine, Division of Pulmonary and Critical Care medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Dittapol Muntham
- Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Faculty of Science and Technology, Rajamangala University of Technology Suvarnabhumi, Phranakhon Si Ayutthaya, Thailand
| | - Naricha Chirakalwasan
- Department of Medicine, Division of Pulmonary and Critical Care medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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15
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Bikov A, Losonczy G, Kunos L. Role of lung volume and airway inflammation in obstructive sleep apnea. Respir Investig 2017; 55:326-333. [PMID: 29153412 DOI: 10.1016/j.resinv.2017.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 08/06/2017] [Accepted: 08/23/2017] [Indexed: 06/07/2023]
Abstract
Obstructive sleep apnea (OSA) is a prevalent disorder that affects not only the upper airways but also the intrathoracic airways. In this review, we summarize the results of studies on lung function and airway inflammation. We provide evidence that the alterations in intrathoracic airways observed in OSA are not purely consequences of mechanical trauma and oxidative stress during apneic events but have a causal role in the structural changes associated with OSA and increasing severity of this disorder.
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Affiliation(s)
- Andras Bikov
- Department of Pulmonology, Semmelweis University, Budapest, Hungary.
| | - Gyorgy Losonczy
- Department of Pulmonology, Semmelweis University, Budapest, Hungary.
| | - Laszlo Kunos
- Department of Pulmonology, Semmelweis University, Budapest, Hungary.
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16
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Luo Y, Luo Y, Li Y, Zhou L, Zhu Z, Chen Y, Huang Y, Chen X. Helmet CPAP versus Oxygen Therapy in Hypoxemic Acute Respiratory Failure: A Meta-Analysis of Randomized Controlled Trials. Yonsei Med J 2016; 57:936-41. [PMID: 27189288 PMCID: PMC4951471 DOI: 10.3349/ymj.2016.57.4.936] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/02/2015] [Accepted: 10/05/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The efficacy of helmet continuous positive airway pressure (CPAP) in hypoxemic acute respiratory failure (hARF) remains unclear. The aim of this meta-analysis was to critically review studies that investigated the effect of helmet CPAP on gas exchange, mortality, and intubation rate in comparison with standard oxygen therapy. MATERIALS AND METHODS We performed a meta-analysis of randomized controlled trials (RCTs) by searching the PubMed, Embase, Cochrane library, OVID, and CBM databases, and the bibliographies of the retrieved articles. Studies that enrolled adults with hARF who were treated with helmet CPAP and measured at least one of the following parameters were included: gas exchange, intubation rate, in-hospital mortality rate. RESULTS Four studies with 377 subjects met the inclusion criteria and were analyzed. Compared to the standard oxygen therapy, helmet CPAP significantly increased the PaO₂/FiO₂ [weighted mean difference (WMD)=73.40, 95% confidence interval (95% CI): 43.92 to 102.87, p<0.00001], and decreased the arterial carbon dioxide levels (WMD=-1.92, 95% CI: -3.21 to -0.63, p=0.003), intubation rate [relative risk (RR)=0.21, 95% CI: 0.11 to 0.40, p<0.00001], and in-hospital mortality rate (RR=0.22, 95% CI: 0.09 to 0.50, p=0.0004). CONCLUSION The results of this meta-analysis suggest that helmet CPAP improves oxygenation and reduces mortality and intubation rates in hARF. However, the significant clinical and statistical heterogeneity of the literature implies that large RCTs are needed to determine the role of helmet CPAP in different hypoxemic ARF populations.
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Affiliation(s)
- Yuwen Luo
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Luo
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yun Li
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Luqian Zhou
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou Medical University, Guangzhou, China
| | - Zhe Zhu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yitai Chen
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yuxia Huang
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xin Chen
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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17
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Singh PM, Borle A, Shah D, Sinha A, Makkar JK, Trikha A, Goudra BG. Optimizing Prophylactic CPAP in Patients Without Obstructive Sleep Apnoea for High-Risk Abdominal Surgeries: A Meta-regression Analysis. Lung 2016; 194:201-17. [DOI: 10.1007/s00408-016-9855-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 02/05/2016] [Indexed: 01/29/2023]
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18
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[Non-invasive mechanical ventilation in postoperative patients. A clinical review]. ACTA ACUST UNITED AC 2015; 62:512-22. [PMID: 25892605 DOI: 10.1016/j.redar.2015.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 11/20/2022]
Abstract
Non-invasive ventilation (NIV) is a method of ventilatory support that is increasing in importance day by day in the management of postoperative respiratory failure. Its role in the prevention and treatment of atelectasis is particularly important in the in the period after thoracic and abdominal surgeries. Similarly, in the transplanted patient, NIV can shorten the time of invasive mechanical ventilation, reducing the risk of infectious complications in these high-risk patients. It has been performed A systematic review of the literature has been performed, including examining the technical, clinical experiences and recommendations concerning the application of NIV in the postoperative period.
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19
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Smith SB, Carr S, Psikula S, Das A, Grichnik K. A Pilot Study on the Effect of Nasal Continuous Positive Airway Pressure on Arterial Partial Pressure of Carbon Dioxide During Spinal Anesthesia with Intravenous Sedation for Total Knee Arthroplasty. Anesth Analg 2015; 120:479-83. [DOI: 10.1213/ane.0000000000000536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Staffieri F, Crovace A, De Monte V, Centonze P, Gigante G, Grasso S. Noninvasive continuous positive airway pressure delivered using a pediatric helmet in dogs recovering from general anesthesia. J Vet Emerg Crit Care (San Antonio) 2014; 24:578-85. [DOI: 10.1111/vec.12210] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 06/27/2014] [Indexed: 01/03/2023]
Affiliation(s)
- Francesco Staffieri
- Dipartimento dell’Emergenza e dei Trapianti d’Organo; Sezione di Cliniche Veterinarie e Produzioni Animali
| | - Antonio Crovace
- Dipartimento dell’Emergenza e dei Trapianti d’Organo; Sezione di Cliniche Veterinarie e Produzioni Animali
| | - Valentina De Monte
- Dipartimento dell’Emergenza e dei Trapianti d’Organo; Sezione di Cliniche Veterinarie e Produzioni Animali
| | - Paola Centonze
- Dipartimento dell’Emergenza e dei Trapianti d’Organo; Sezione di Cliniche Veterinarie e Produzioni Animali
| | - Giulio Gigante
- Dipartimento dell’Emergenza e dei Trapianti d’Organo; Sezione di Cliniche Veterinarie e Produzioni Animali
| | - Salvatore Grasso
- Dipartimento dell’Emergenza e dei Trapianti d’Organo; Sezione di Anestesiologia e Rianimazione; SP per Casamassima km 3, 70010 Valenzano Bari Italy
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Ireland CJ, Chapman TM, Mathew SF, Herbison GP, Zacharias M. Continuous positive airway pressure (CPAP) during the postoperative period for prevention of postoperative morbidity and mortality following major abdominal surgery. Cochrane Database Syst Rev 2014; 2014:CD008930. [PMID: 25081420 PMCID: PMC6464713 DOI: 10.1002/14651858.cd008930.pub2] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Major abdominal surgery can be associated with a number of serious complications that may impair patient recovery. In particular, postoperative pulmonary complications (PPCs), including respiratory complications such as atelectasis and pneumonia, are a major contributor to postoperative morbidity and may even contribute to increased mortality. Continuous positive airway pressure (CPAP) is a type of therapy that uses a high-pressure gas source to deliver constant positive pressure to the airways throughout both inspiration and expiration. This approach is expected to prevent some pulmonary complications, thus reducing mortality. OBJECTIVES To determine whether any difference can be found in the rate of mortality and adverse events following major abdominal surgery in patients treated postoperatively with CPAP versus standard care, which may include traditional oxygen delivery systems, physiotherapy and incentive spirometry. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2013, Issue 9; Ovid MEDLINE (1966 to 15 September 2013); EMBASE (1988 to 15 September 2013); Web of Science (to September 2013) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (to September 2013). SELECTION CRITERIA We included all randomized controlled trials (RCTs) in which CPAP was compared with standard care for prevention of postoperative mortality and adverse events following major abdominal surgery. We included all adults (adults as defined by individual studies) of both sexes. The intervention of CPAP was applied during the postoperative period. We excluded studies in which participants had received PEEP during surgery. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies that met the selection criteria from all studies identified by the search strategy. Two review authors extracted the data and assessed risk of bias separately, using a data extraction form. Data entry into RevMan was performed by one review author and was checked by another for accuracy. We performed a limited meta-analysis and constructed a summary of findings table. MAIN RESULTS We selected 10 studies for inclusion in the review from 5236 studies identified in the search. These 10 studies included a total of 709 participants. Risk of bias for the included studies was assessed as high in six studies and as unclear in four studies.Two RCTs reported all-cause mortality. Among 413 participants, there was no clear evidence of a difference in mortality between CPAP and control groups, and considerable heterogeneity between trials was noted (risk ratio (RR) 1.28, 95% confidence interval (CI) 0.35 to 4.66; I(2) = 75%).Six studies reported demonstrable atelectasis in the study population. A reduction in atelectasis was observed in the CPAP group, although heterogeneity between studies was substantial (RR 0.62, 95% CI 0.45 to 0.86; I(2) = 61%). Pneumonia was reported in five studies, including 563 participants; CPAP reduced the rate of pneumonia, and no important heterogeneity was noted (RR 0.43, 95% CI 0.21 to 0.84; I(2) = 0%). The number of participants identified as having serious hypoxia was reported in two studies, with no clear difference between CPAP and control groups, given imprecise results and substantial heterogeneity between trials (RR 0.48, 95% CI 0.22 to 1.02; I(2) = 67%). A reduced rate of reintubation was reported in the CPAP group compared with the control group in two studies, and no important heterogeneity was identified (RR 0.14, 95% CI 0.03 to 0.58; I(2) = 0%). Admission into the intensive care unit (ICU) for invasive ventilation and supportive care was reduced in the CPAP group, but this finding did not reach statistical significance (RR 0.45, 95% CI 0.18 to 1.14; I(2) = 0).Secondary outcomes such as length of hospital stay and adverse effects were only minimally reported.A summary of findings table was constructed using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) principle. The quality of evidence was determined to be very low. AUTHORS' CONCLUSIONS Very low-quality evidence from this review suggests that CPAP initiated during the postoperative period might reduce postoperative atelectasis, pneumonia and reintubation, but its effects on mortality, hypoxia or invasive ventilation are uncertain. Evidence is not sufficiently strong to confirm the benefits or harms of CPAP during the postoperative period in those undergoing major abdominal surgery. Most of the included studies did not report on adverse effects attributed to CPAP.New, high-quality research is much needed to evaluate the use of CPAP in preventing mortality and morbidity following major abdominal surgery. With increasing availability of CPAP to our surgical patients and its potential to improve outcomes (possibly in conjunction with intraoperative lung protective ventilation strategies), unanswered questions regarding its efficacy and safety need to be addressed. Any future study must report on the adverse effects of CPAP.
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Affiliation(s)
- Claire J Ireland
- Dunedin HospitalDepartment of Anaesthesia & Intensive CareGreat King StreetDunedinNew Zealand
| | - Timothy M Chapman
- Christchurch Public HospitalDepartment of Anaesthesia2 Riccarton AveChristchurchNew Zealand4710
| | - Suneeth F Mathew
- University of AucklandMedical Student at School of Medicine85 Park RoadGraftonAucklandNew Zealand1023
| | - G Peter Herbison
- Dunedin School of Medicine, University of OtagoDepartment of Preventive & Social MedicinePO Box 913DunedinNew Zealand9054
| | - Mathew Zacharias
- Dunedin HospitalDepartment of Anaesthesia & Intensive CareGreat King StreetDunedinNew Zealand
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A randomized clinical trial evaluating nasal continuous positive airway pressure for acute respiratory distress in a developing country. J Pediatr 2013; 162:988-92. [PMID: 23164308 DOI: 10.1016/j.jpeds.2012.10.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/27/2012] [Accepted: 10/08/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Invasive mechanical ventilation is often not an option for children with acute respiratory infections in developing countries. An alternative is continuous positive airway pressure (CPAP). The authors evaluated the effectiveness of CPAP in children presenting with acute respiratory distress in a developing country. STUDY DESIGN A randomized, controlled trial was conducted in 4 rural hospitals in Ghana. Children, 3 months to 5 years of age, presenting with tachypnea and intercostal or subcostal retractions or nasal flaring were randomly assigned to receive CPAP immediately or 1 hour after presentation. CPAP was applied by locally trained nurses. The primary outcome measure was change in respiratory rate at 1 hour. RESULTS The study was stopped after the enrollment of 70 subjects because of a predetermined stop value of P < .001. Mean respiratory rate of children who received immediate CPAP fell by 16 breaths/min (95% CI 10-21) in the first hour compared with no change in children who had CPAP delayed by 1 hour (95% CI -2 to +5). Thirty-five of the patients had a positive malaria blood smear. There were 3 deaths as a result of severe malaria. No major complications of CPAP use were noted. CONCLUSIONS CPAP decreases respiratory rate in children with respiratory distress compared with children not receiving CPAP. The technology was successfully used by local nurses. No complications were associated with its use. CPAP is a relatively low-cost, low-technology that is a safe method to decrease respiratory rate in children with nonspecific respiratory distress.
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Murase K, Chihara Y, Takahashi K, Okamoto S, Segawa H, Fukuda K, Tanaka K, Uemoto S, Mishima M, Chin K. Use of noninvasive ventilation for pediatric patients after liver transplantation: decrease in the need for reintubation. Liver Transpl 2012; 18:1217-25. [PMID: 22692821 DOI: 10.1002/lt.23491] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Noninvasive ventilation (NIV) refers to ventilation delivered through a noninvasive interface (a nasal or face mask) rather than an invasive interface (an endotracheal tube or tracheostomy). The role of NIV in preventing reintubation after abdominal surgery in pediatric patients is uncertain. Therefore, we evaluated the role of NIV for this purpose in pediatric patients after liver transplantation. We successfully started using NIV for respiratory complications (RCs) in pediatric patients undergoing liver transplantation in 1999. For this report, we screened all medical records of patients under the age of 12 years who underwent liver transplantation between 2001 and 2009, and we retrieved data for cases at high risk of extubation failure. We retrospectively compared the clinical outcomes of patients who received NIV during their intensive care unit (ICU) stay and patients who did not. Data for 94 cases (92 patients) were included in this analysis. NIV was used in 47 patients during their ICU stay. The rate of reintubation for RCs was significantly lower in NIV patients versus non-NIV patients [3/47 (6.4%) versus 11/47 (23.4%), P = 0.02]. Furthermore, the discharge rate from the ICU was significantly better for NIV patients versus non-NIV patients. The use of NIV after extubation prevented the worsening of atelectasis and stabilized respiratory conditions in this cohort. No major changes in operative procedures or other treatments during the examined period were found. In conclusion, NIV is acceptable and promising for the respiratory management of pediatric patients undergoing liver transplantation. Its use may stabilize respiratory conditions and decrease the need for reintubation in pediatric liver transplant patients, and it may also facilitate an early ICU discharge.
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Affiliation(s)
- Kimihiko Murase
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Sakyo, Kyoto, Japan
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Liao G, Chen R, He J. Prophylactic use of noninvasive positive pressure ventilation in post-thoracic surgery patients: A prospective randomized control study. J Thorac Dis 2012; 2:205-9. [PMID: 22263048 DOI: 10.3978/j.issn.2072-1439.2010.02.04.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 10/10/2010] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Prospective randomized controlled study was conducted to explore the effects and safety of prophylactic use of noninvasive positive pressure ventilation (NPPV) in post-thoracic surgery (PTS) patients, especially on the lung re-expansion, lung function change and postoperative pulmonary complications (PPCs). METHODS Fifty PTS patients met the inclusion criterion were enrolled in the study. All subjects were randomly divided into conventional treatment (control) group and NPPV group. NPPV group received intermittent NPPV therapy in first three days of PTS. BiPAP ventilator was used with S/T mode in the study. The average IPAP was (13±3.2)cmH(2)O (ranged from 7 to 18 cmH(2)O) and EPAP was 4cmH(2)O. Total ventilation time was (13.5±4.9) hours (ranged from 6.5 to 23 hours). PPCs rate, lung re-expansion, the volume of residual cavity, lung function and tolerance to NPPV were assessed with chest roentgenography, CT scan, lung function testing and clinical evaluation before and one week after surgery. RESULTS 1. There was no significant difference of total PPCs rate during hospitalization between the two groups (5/23 in NPPV group vs 6/27 in control group, P= 0.967). Multiple factorial logistic regression analysis showed that COPD was a risk factor for PPCs (B=1.705, P=0.027). 2. Compared with control group, NPPV therapy reduced inadequate lung expansion rate (3/23 vs 13/27, P=0.008) and volume of residual cavity calculated with CT scan [(31.9±71.7)ml vs (63.6±78.3)ml, P=0.02]. However, there were no significant difference in the change of lung function parameters after operation between the two groups (all P>0.05). No significant adverse effects of NPPV were found in the present study. CONCLUSIONS In the current study of prophylactic application of NPPV in post-thoracic surgery patients, the use of NPPV resulted in improved lung re-expansion, but had no significant effects on post-operative pulmonary complications and lung functions.
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Affiliation(s)
- Guangyuan Liao
- State Key Lab of Respiratory Disease (The First Affiliated Hospital of Guangzhou Medical College)
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Remístico PPJ, Araújo S, de Figueiredo LC, Aquim EE, Gomes LM, Sombrio ML, Ambiel SDF. Impact of alveolar recruitment maneuver in the postoperative period of videolaparoscopic bariatric surgery. Rev Bras Anestesiol 2011; 61:163-8, 169-76, 88-94. [PMID: 21474024 DOI: 10.1016/s0034-7094(11)70021-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 09/09/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pulmonary complications in bariatric surgery are common and, therefore, alveolar recruitment maneuvers (ARM) have been used to prevent or reduce them in the postoperative period (POP). The aim of this study was to evaluate the impact of ARM performed intraoperatively in patients undergoing bariatric surgery by videolaparoscopy in the incidence of postoperative pulmonary complications. METHODS Randomized clinical trial with 30 patients divided into control group (CG) and experimental group (EG), with analysis of spirometric, ventilatory, hemodynamic, and radiographic variables. ARM was performed in EG with positive end expiratory pressure of 30 cmH₂O and inspiratory plateau pressure of 45 cmH₂O for 2 minutes after pneumoperitoneum deflation. RESULTS We observed a significant decrease in spirometric values (p ≤ 0.001) and higher incidence of pulmonary complications on chest radiograph (p=0.02) in CG, as well as significant improvement in dyspnoea Borg scale (p ≤ 0.001) in EG. CONCLUSIONS We conclude that ARM is a safe and effective technique when used for prevention of pulmonary complications in patients undergoing bariatric surgery, resulting in more favorable radiological and spirometric findings in the experimental group compared to the control group in the PO.
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Affiliation(s)
- Paula Patelli Juliani Remístico
- Faculty of Medical Sciences, Universidade Estadual de Campinas Rua Tessália Vieira de Camargo, 126 Cidade Universitária "Zeferino Vaz" 13083-887, PO Box 6111-Campinas, SP, Brazil.
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Zoremba M, Kalmus G, Begemann D, Eberhart L, Zoremba N, Wulf H, Dette F. Short term non-invasive ventilation post-surgery improves arterial blood-gases in obese subjects compared to supplemental oxygen delivery - a randomized controlled trial. BMC Anesthesiol 2011; 11:10. [PMID: 21605450 PMCID: PMC3117807 DOI: 10.1186/1471-2253-11-10] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 05/23/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the immediate postoperative period, obese patients are more likely to exhibit hypoxaemia due to atelectasis and impaired respiratory mechanics, changes which can be attenuated by non-invasive ventilation (NIV). The aim of the study was to evaluate the duration of any effects of early initiation of short term pressure support NIV vs. traditional oxygen delivery via venturi mask in obese patients during their stay in the PACU. METHODS After ethics committee approval and informed consent, we prospectively studied 60 obese patients (BMI 30-45) undergoing minor peripheral surgery. Half were randomly assigned to receive short term NIV during their PACU stay, while the others received routine treatment (supplemental oxygen via venturi mask). Premedication, general anaesthesia and respiratory settings were standardized. We measured arterial oxygen saturation by pulse oximetry and blood gas analysis on air breathing. Inspiratory and expiratory lung function was measured preoperatively (baseline) and at 10 min, 1 h, 2 h, 6 h and 24 h after extubation, with the patient supine, in a 30 degrees head-up position. The two groups were compared using repeated-measure analysis of variance (ANOVA) and t-test analysis. Statistical significance was considered to be P < 0.05. RESULTS There were no differences at the first assessment. During the PACU stay, pulmonary function in the NIV group was significantly better than in the controls (p < 0.0001). Blood gases and the alveolar to arterial oxygen partial pressure difference were also better (p < 0.03), but with the addition that overall improvements are of questionable clinical relevance. These effects persisted for at least 24 hours after surgery (p < 0.05). CONCLUSION Early initiation of short term NIV during in the PACU promotes more rapid recovery of postoperative lung function and oxygenation in the obese. The effect lasted 24 hours after discontinuation of NIV. Patient selection is necessary in order to establish clinically relevant improvements. TRIAL REGISTRATION#: DRKS00000751; http://www.germanctr.de.
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Affiliation(s)
- Martin Zoremba
- Department of Anaesthesia and Intensive Care Medicine, University of Marburg, D-35033 Marburg, Germany.
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Influence of lung collapse distribution on the physiologic response to recruitment maneuvers during noninvasive continuous positive airway pressure. Intensive Care Med 2011; 37:1095-102. [PMID: 21567113 DOI: 10.1007/s00134-011-2239-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 03/14/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Noninvasive continuous positive airway pressure (n-CPAP) has been proposed for the treatment of hypoxemic acute respiratory failure (h-ARF). Recruitment maneuvers were shown to improve oxygenation, i.e., the ratio of arterial oxygen tension to inspiratory oxygen fraction (PaO2/FiO2), during either invasive mechanical ventilation, and n-CPAP, with a response depending on the distribution of lung collapse. We hypothesized that, during n-CPAP, early h-ARF patients with bilateral (B(L)) distribution of lung involvement would benefit from recruitment maneuvers more than those with unilateral (U(L)) involvement. METHODS To perform a recruitment maneuver, once a minute we increased the pressure applied to the airway from 10 cmH2O to 25 cmH2O for 8 s (SIGH). We enrolled 24 patients with h-ARF (12 B(L) and 12 U(L)) who underwent four consecutive trials: (1) 30 min breathing through a Venturi mask (V(MASK)), (2) 1 h n-CPAP (n-CPAP1), (3) 1 h n-CPAP plus SIGH (n-CPAP(SIGH)), and (4) 1 h n-CPAP (n-CPAP2). RESULTS Compared to V(MASK), n-CPAP at 10 cmH2O delivered via a helmet, increased PaO2/FiO2 and decreased dyspnea in both B(L) and U(L); furthermore, it reduced the respiratory rate and brought PaCO2 up to normal in B(L) only. Compared to n-CPAP, n-CPAP(SIGH) significantly improved PaO2/FiO2 in B(L) (225 ± 88 vs. 308 ± 105, respectively), whereas it produced no further improvement in PaO2/FiO2 in U(L) (232 ± 72 vs. 231 ± 77, respectively). SIGH did not affect hemodynamics in both groups. CONCLUSIONS Compared to n-CPAP, n-CPAP(SIGH) further improved arterial oxygenation in B(L) patients, whereas it produced no additional benefit in those with U(L).
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Chiumello D, Chevallard G, Gregoretti C. Non-invasive ventilation in postoperative patients: a systematic review. Intensive Care Med 2011; 37:918-29. [PMID: 21424246 DOI: 10.1007/s00134-011-2210-8] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 01/20/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND Postoperative pulmonary complications, generally defined as any pulmonary abnormality occurring in the postoperative period, are still a significant issue in clinical practice increasing hospital length of stay, morbidity and mortality. Non-invasive ventilation (NIV), primarily applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic pulmonary failure, is nowadays also used in perioperative settings. OBJECTIVE Investigate the application and results of preventive and therapeutic NIV in postsurgical patients. DESIGN A systematic review. DATA SOURCES Medical literature databases were searched for articles about "clinical trials," "randomized controlled trials" and "meta-analyses." The keywords "cardiac surgery," "thoracic surgery," "lung surgery," "abdominal surgery," "solid organ transplantation," "thoraco-abdominal surgery" and "bariatric surgery" were combined with any of these: "non-invasive positive pressure ventilation," "continuous positive airway pressure," "bilevel ventilation," "postoperative complications," "postoperative care," "respiratory care," "acute respiratory failure," "acute lung injury" and "acute respiratory distress syndrome." RESULTS Twenty-nine articles (N=2,279 patients) met the inclusion criteria. Nine studies evaluated NIV in post-abdominal surgery, three in thoracic surgery, eight in cardiac surgery, three in thoraco-abdominal surgery, four in bariatric surgery and two in post solid organ transplantation used both for prophylactic and therapeutic purposes. NIV improved arterial blood gases in 15 of the 22 prophylactic and in 4 of the 7 therapeutic studies, respectively. NIV reduced the intubation rate in 11 of the 29 studies and improved outcome in only 1. CONCLUSIONS Despite these limited data and the necessity of new randomized trials, NIV could be considered as a prophylactic and therapeutic tool to improve gas exchange in postoperative patients.
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Affiliation(s)
- D Chiumello
- U.O. Anestesia e Rianimazione, Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy.
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Keenan SP, Sinuff T, Burns KEA, Muscedere J, Kutsogiannis J, Mehta S, Cook DJ, Ayas N, Adhikari NKJ, Hand L, Scales DC, Pagnotta R, Lazosky L, Rocker G, Dial S, Laupland K, Sanders K, Dodek P. Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ 2011; 183:E195-214. [PMID: 21324867 DOI: 10.1503/cmaj.100071] [Citation(s) in RCA: 200] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Muñoz Bono J, Curiel Balsera E, Galeas López JL. Indicaciones en ventilación mecánica no invasiva. ¿Evidencias en la bibliografía médica? Med Clin (Barc) 2011; 136:116-20. [DOI: 10.1016/j.medcli.2009.10.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 10/26/2009] [Accepted: 11/03/2009] [Indexed: 10/20/2022]
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Casali CCC, Pereira APM, Martinez JAB, de Souza HCD, Gastaldi AC. Effects of Inspiratory Muscle Training on Muscular and Pulmonary Function After Bariatric Surgery in Obese Patients. Obes Surg 2011; 21:1389-94. [DOI: 10.1007/s11695-010-0349-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Franco AM, Torres FCC, Simon ISL, Morales D, Rodrigues AJ. Avaliação da ventilação não-invasiva com dois níveis de pressão positiva nas vias aéreas após cirurgia cardíaca. Braz J Cardiovasc Surg 2011; 26:582-90. [DOI: 10.5935/1678-9741.20110048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Accepted: 09/05/2011] [Indexed: 11/20/2022] Open
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Prevention and reversal of lung collapse during the intra-operative period. Best Pract Res Clin Anaesthesiol 2010; 24:183-97. [PMID: 20608556 DOI: 10.1016/j.bpa.2010.02.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
General anaesthesia induces ventilation/perfusion mismatch by lung collapse. Such lung collapse predisposes patients to preoperative complications since it can persist for several hours or days after surgery. Atelectasis can be partially prevented by using continuous positive airway pressure (CPAP) and/or by lowering FiO2 during anaesthesia induction. However, these manoeuvres are dangerous for patients presenting with challenging airway or ventilator conditions. Lung recruitment manoeuvres (RMs) are ventilatory strategies that aim to restore the aeration of normal lungs. They consist of a brief and controlled increment in airway pressure to open up collapsed areas of the lungs and sufficient positive end-expiratory pressure (PEEP) to keep them open afterward. The application of RMs during anaesthesia normalises lung function along the intraoperative period. There is physiological evidence that patients of all ages and any kind of surgery benefit from such an active intervention. The effect of RMs on patient outcome in the postoperative period is, however, not yet known.
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Zarbock A, Mueller E, Netzer S, Gabriel A, Feindt P, Kindgen-Milles D. Prophylactic Nasal Continuous Positive Airway Pressure Following Cardiac Surgery Protects From Postoperative Pulmonary Complications. Chest 2009; 135:1252-1259. [DOI: 10.1378/chest.08-1602] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Glover GW, Fletcher SJ. Assessing the performance of the Whisperflow continuous positive airway pressure generator: a bench study. Br J Anaesth 2009; 102:875-81. [PMID: 19380311 DOI: 10.1093/bja/aep077] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There are few data describing the performance of the Whisperflow continuous positive airway pressure (CPAP) generator. METHODS (i) (a) A static test of 11 Whisperflow devices examining maximum flow generation with no load and with 2.5, 5, 7.5, 10, 15, and 20 cm H2O valve loading, at varying Fi(O2). (b) CPAP valves (Accu-peep(R), Vital Signs, Totowa, NJ, USA) were tested by measuring mean upstream pressure at varying flows in five valves (2.5, 5, 7.5, 10, 15, and 20 cm H2O). (ii) We measured the mean and minimum inspiratory mask pressure generated by a representative Whisperflow device in a model of spontaneous respiration. Measurements were made with combinations of Fi(O2), ventilatory frequency, tidal volume, and valve loading similar to those encountered in clinical practice. RESULTS (i) (a) The flow generated by the Whisperflow valves decreases with increasing valve load and increasing Fi(O2) (from 140 to 20 litre min(-1)). (b) The CPAP valves maintain the required pressure within acceptable limits against varying flow. (ii) At all permutations, the mean inspiratory mask pressure was significantly lower than that required. At high inspiratory flow rates, the minimum inspiratory pressure approached atmospheric pressure. CONCLUSIONS The Whisperflow may not perform as expected. Clinicians should be cautious when using this device, particularly with high Fi(O2) and CPAP valve load. The flow setting should be set at maximum. Failure of CPAP therapy may be due to failure of the generator. Further in vivo data are required.
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Affiliation(s)
- G W Glover
- Intensive Care Unit, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford BD9 6RJ, UK
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Continuous Positive Airway Pressure for Treatment of Respiratory Complications After Abdominal Surgery. Ann Surg 2008; 247:617-26. [DOI: 10.1097/sla.0b013e3181675829] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Mechanical Ventilation. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sutyak JP, Wohltmann CD, Larson J. Pulmonary contusions and critical care management in thoracic trauma. Thorac Surg Clin 2007; 17:11-23, v. [PMID: 17650693 DOI: 10.1016/j.thorsurg.2007.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Many victims of thoracic trauma require ICU care and mechanical ventilatory support. Pressure and volume-limited modes assist in the prevention of ventilator-associated lung injury. Ventilator-associated pneumonia is a significant cause of posttraumatic morbidity and mortality. Minimizing ventilator days, secretion control, early nutritional support, and patient positioning are methods to reduce the risk of pneumonia.
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Affiliation(s)
- John P Sutyak
- Southern Illinois Trauma Center, Southern Illinois University, P.O. Box 19663, Springfield, IL 62794, USA.
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Pasquina P, Tramèr MR, Granier JM, Walder B. Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery: a systematic review. Chest 2007; 130:1887-99. [PMID: 17167013 DOI: 10.1378/chest.130.6.1887] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES To examine the efficacy of respiratory physiotherapy for prevention of pulmonary complications after abdominal surgery. METHODS We searched in databases and bibliographies for articles in all languages through November 2005. Randomized trials were included if they investigated prophylactic respiratory physiotherapy and pulmonary outcomes, and if the follow-up was at least 2 days. Efficacy data were expressed as risk differences (RDs) and number needed to treat (NNT), with 95% confidence intervals (CIs). RESULTS Thirty-five trials tested respiratory physiotherapy treatments. Of 13 trials with a "no intervention" control group, 9 studies (n = 883) did not report on significant differences, and 4 studies (n = 528) did: in 1 study, the incidence of pneumonia was decreased from 37.3 to 13.7% with deep breathing, directed cough, and postural drainage (RD, 23.6%; 95% CI, 7 to 40%; NNT, 4.3; 95% CI, 2.5 to 14); in 1 study, the incidence of atelectasis was decreased from 39 to 15% with deep breathing and directed cough (RD, 24%; 95% CI, 5 to 43%; NNT, 4.2; 95% CI, 2.4 to 18); in 1 study, the incidence of atelectasis was decreased from 77 to 59% with deep breathing, directed cough, and postural drainage (RD, 18%; 95% CI, 5 to 31%; NNT, 5.6; 95% CI, 3.3 to 19); in 1 study, the incidence of unspecified pulmonary complications was decreased from 47.7% to 21.4 to 22.2% with intermittent positive pressure breathing, or incentive spirometry, or deep breathing with directed cough (RD, 25.5 to 26.3%; NNT, 3.8 to 3.9). Twenty-two trials (n = 2,734) compared physiotherapy treatments without no intervention control subjects; no conclusions could be drawn. CONCLUSIONS There are only a few trials that support the usefulness of prophylactic respiratory physiotherapy. The routine use of respiratory physiotherapy after abdominal surgery does not seem to be justified.
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Affiliation(s)
- Patrick Pasquina
- Division of Intensive Care, Geneva University Hospitals, 1211 Geneva 14, Switzerland.
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Bergman SA, Coletti D. Perioperative management of the geriatric patient. Part I: respiratory system. ACTA ACUST UNITED AC 2006; 102:e1-6. [PMID: 16920526 DOI: 10.1016/j.tripleo.2005.03.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2004] [Revised: 03/02/2005] [Accepted: 03/17/2005] [Indexed: 11/16/2022]
Abstract
The population of the United States is aging. It is expected that the population age 65 and older will increase to nearly 60 million by the year 2030 and those age 85 and over to nearly 11 million. Patients over age 65 are more than twice as likely to undergo surgical procedures than patients 40 to 65. Structural and physiologic changes associated with advancing age, combined with the increased likelihood of major disability or disease, significantly increase the risk of perioperative complications. These articles review the major age-related changes and the effect they have on the perioperative management of these patients.
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Affiliation(s)
- Stewart A Bergman
- Department of Oral and Maxillofacial Surgery, Baltimore College of Dental Surgery, University of Maryland Dental School, Baltimore, MD 21201, USA.
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Kindgen-Milles D, Müller E, Buhl R, Böhner H, Ritter D, Sandmann W, Tarnow J. Nasal-Continuous Positive Airway Pressure Reduces Pulmonary Morbidity and Length of Hospital Stay Following Thoracoabdominal Aortic Surgery. Chest 2005; 128:821-8. [PMID: 16100174 DOI: 10.1378/chest.128.2.821] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Patients who undergo surgical repair of thoracoabdominal aortic aneurysms have a high risk for the development of respiratory complications, which cause significant postoperative morbidity and prolong hospitalization, compared to patients who undergo other types of surgery. We studied whether prophylactic noninvasive application of nasal continuous positive airway pressure (nCPAP) administered via a facemask immediately after extubation may reduce pulmonary morbidity and shorten the length of hospitalization. DESIGN Prospective randomized clinical trial. SETTING Surgical ICU of a university hospital. PATIENTS Fifty-six patients following elective prosthetic replacement of the thoracoabdominal aorta, of whom 6 patients were excluded because they had received prolonged mechanical ventilation. INTERVENTIONS Following extubation in the ICU, nCPAP was applied for 12 to 24 h at an airway pressure of 10 cm H2O to patients in the study group (n = 25). Subjects in the control group (n = 25) received standard treatment including intermittent nCPAP (10 cm H2O for 10 min) every 4 h. MEASUREMENTS AND RESULTS In the study group, nCPAP was applied for a mean (+/- SD) duration of 23 +/- 3 h at an airway pressure of 10 +/- 1 cm H2O, which improved pulmonary oxygen transfer without altering hemodynamics (ie, heart rate, mean arterial BP, and central venous pressure). The application of nCPAP was associated with fewer pulmonary complications (Pa(O2)/fraction of inspired oxygen [F(IO2)] <100, atelectasis, pneumonia, reintubation rate) compared to the control group (7 of 25 patients vs 24 of 25 subjects, respectively; p = 0.019). The mean duration of intensive care treatment tended to be shorter in the study group compared to the control group (8 +/- 1 vs 12 +/- 2 days, respectively; difference not significant), while the mean length of hospital stay was shorter with nCPAP therapy (22 +/- 2 vs 34 +/- 5 days, respectively; p = 0.048). CONCLUSIONS The prophylactic application of nCPAP at airway pressures of 10 cm H2O significantly reduced pulmonary morbidity and length of hospital stay following the surgical repair of thoracoabdominal aortic aneurysms. Thus, it can be recommended as a standard treatment procedure for this patient group.
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Foster R, Scales DC. Can CPAP prevent the need for endotracheal intubation in patients with hypoxemia after abdominal surgery? CMAJ 2005; 172:744. [PMID: 15772998 PMCID: PMC552885 DOI: 10.1503/cmaj.050193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ryan Foster
- Department of Critical Care, St. Michael's Hospital, Toronto, Ont
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Affiliation(s)
- Robert D Acton
- Department of Surgery, Regions Hospital, St. Paul, Minnesota 55101, USA
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Denehy L, Carroll S, Ntoumenopoulos G, Jenkins S. A randomized controlled trial comparing periodic mask CPAP with physiotherapy after abdominal surgery. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2002; 6:236-50. [PMID: 11833245 DOI: 10.1002/pri.231] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE Physiotherapists use a variety of techniques aimed at improving lung volumes and secretion clearance in patients after surgery. Periodic continuous positive airway pressure (PCPAP) is used to treat patients following elective upper abdominal surgery. However, the optimal method of application has not been identified, more specifically, the dosage of application of PCPAP. The present randomized controlled trial compared the effects of two dosages of PCPAP application and 'traditional' physiotherapy upon functional residual capacity (FRC), vital capacity (VC), oxyhaemoglobin saturation (SpO2), incidence of post-operative pulmonary complications and length of stay with a control group receiving 'traditional' physiotherapy only. METHOD Fifty-seven subjects were randomly allocated to one of three groups. All groups received 'traditional' physiotherapy twice daily for a minimum of three post-operative days. In addition, two groups received PCPAP for 15 or 30 minutes, four times per day, for three days. RESULTS Fifty subjects (39 male; 11 female) completed the study. There were no significant differences in any variables between the three groups. The overall incidence of post-operative pulmonary complications was 22% in the control group, 11% and 6% in the PCPAP 15-minute and PCPAP 30-minute groups, respectively. Length of hospital stay was not significantly different between the groups but for subjects who developed post-operative pulmonary complications, the length of stay was significantly greater (Z = -2.32; p = 0.021). CONCLUSIONS The addition of PCPAP to a traditional physiotherapy post-operative treatment regimen after upper abdominal surgery did not significantly affect physiological or clinical outcomes.
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Affiliation(s)
- L Denehy
- School of Physiotherapy, University of Melbourne, Australia.
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Abstract
The aim of this paper is to review the indications for use by physiotherapists, such as physiological rationale and the comparative efficacy of intermittent positive pressure breathing (IPPB) and continuous positive airway pressure (CPAP). A brief discussion of nasal intermittent positive airway pressure is also included. The use of IPPB for post operative prophylaxis has not been supported in the literature. In patients with low lung volumes resulting from neuromuscular disease or spinal injury, IPPB may be useful in the acute phase to improve tidal volume and cough effectiveness. The physiological benefits of CPAP to improve lung volumes are well documented in the literature. Physiotherapists use CPAP as an intermittent application in patients with low lung volumes following surgery. It is predominantly used as a second line intervention in the presence of refractory atelectasis and poor gas exchange. It may also be indicated in other patient groups with similar physiological problems. Nasal intermittent positive airway pressure combines the beneficial effects of intermittent positive pressure breathing and continuous positive airway pressure. There have been many studies evaluating its effectiveness. These have been supportive for patients with neuromuscular disease and sleep disordered breathing, but more research is needed in patients with acute respiratory failure.
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Affiliation(s)
- L Denehy
- School of Physiotherapy, The University of Melbourne, Australia
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Doherty MJ, Millner PA, Latham M, Dickson RA, Elliott MW. Non-invasive ventilation in the treatment of ventilatory failure following corrective spinal surgery. Anaesthesia 2001; 56:235-8. [PMID: 11251430 DOI: 10.1046/j.1365-2044.2001.01422.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Non-invasive positive pressure ventilation has previously been used successfully to treat both acute and chronic ventilatory failure secondary to a number of conditions, including scoliosis. We report two patients in whom it was used, on three separate occasions, to treat acute ventilatory failure following corrective spinal surgery. Non-invasive positive pressure ventilation may be useful postoperatively in high-risk patients undergoing major spinal surgery in an attempt to prevent intubation and its attendant complications.
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Affiliation(s)
- M J Doherty
- Department of Respiratory Medicine, St. James's University Hospital, Beckett Street, Leeds, UK
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