Continuous positive airway pressure effect on functional residual capacity, vital capacity and its subdivisions. A surgical safety checklist to reduce morbidity and mortality in a global population. Nasal-continuous positive airway pressure reduces pulmonary morbidity and length of hospital stay following thoracoabdominal aortic surgery. Outcomes of patients with acute respiratory failure after abdominal surgery treated with noninvasive positive pressure ventilation. Continuous Positive Airway Pressure via the Boussignac System Immediately after Extubation Improves Lung Function in Morbidly Obese Patients with Obstructive Sleep Apnea Undergoing Laparoscopic Bariatric Surgery Is gastroduodenitis part of the spectrum of peptic ulcer disease? Prophylactic nasal continuous positive airway pressure after major vascular surgery: results of a prospective randomized trial [Use of noninvasive ventilation in patients at high postoperative risk for cardiopulmonary complications]. Can postoperative continuous positive airway pressure (CPAP) prevent pulmonary complications after abdominal surgery? A randomized controlled trial comparing periodic mask CPAP with physiotherapy after abdominal surgery. Effect of bi-level positive airway pressure (BiPAP) nasal ventilation on the postoperative pulmonary restrictive syndrome in obese patients undergoing gastroplasty. Effects of periodic positive airway pressure by mask on postoperative pulmonary function. Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. Boussignac CPAP in the Postoperative Period in Morbidly Obese Patients Multifactorial Risk Index for Predicting Postoperative Respiratory Failure in Men After Major Noncardiac Surgery Safety and efficacy of postoperative continuous positive airway pressure to prevent pulmonary complications after Roux-en-Y gastric bypass Randomized clinical study of the prevention of pulmonary complications after thoracoabdominal resection by two different breathing techniques Postoperative pulmonary complications and lung function in high‐risk patients: a comparison of three physiotherapy regimens after upper abdominal surgery in general anesthesia Automatic CPAP Compared with Conventional Treatment for Episodic Hypoxemia and Sleep Disturbance after Major Abdominal Surgery A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. [Effects of three types of respiratory assistance (continuous positive pressure, intermittent positive pressure, classical respiratory physiotherapy) on PaO2 and PaCO2 in patients undergoing digestive tract surgery]. [The effect of intraoperative PEEP ventilation and postoperative CPAP breathing on postoperative lung function following upper abdominal surgery]. Postoperative spontaneous breathing with CPAP to normalize late postoperative oxygenation Nasal continuous positive airway pressure: an alternative method for respiratory assistance. The effect of bi-level positive airway pressure on postoperative pulmonary function following gastric surgery for obesity. [EzPAP® therapy of postoperative hypoxemia in the recovery room : experiences with the new compact system of end-expiratory positive airway pressure]. A comparison between the Boussignac™ continuous positive airway pressure mask and the venturi mask in terms of improvement in the PaO2/FiO2 ratio in morbidly obese patients undergoing bariatric surgery: a randomized controlled trial
Thirty-four otherwise healthy patients having to undergo elective upper abdominal surgery were r and omly assigned to two equal groups . In the treatment group , constant positive airway pressure ( CPAP ) with an expiratory pressure of 12 cm H2O was applied at one hour following extubation , and at daily intervals for the first five days following surgery for a continuous period of three hours . The control group received no CPAP treatment . All patients were given postoperative physiotherapy . In patients who received postoperative CPAP with an end-expiratory pressure of 12 cm H2O , marked normalization of pulmonary function was noted BACKGROUND Surgery has become an integral part of global health care , with an estimated 234 million operations performed yearly . Surgical complications are common and often preventable . We hypothesized that a program to implement a 19-item surgical safety checklist design ed to improve team communication and consistency of care would reduce complications and deaths associated with surgery . METHODS Between October 2007 and September 2008 , eight hospitals in eight cities ( Toronto , Canada ; New Delhi , India ; Amman , Jordan ; Auckl and , New Zeal and ; Manila , Philippines ; Ifakara , Tanzania ; London , Engl and ; and Seattle , WA ) representing a variety of economic circumstances and diverse population s of patients participated in the World Health Organization 's Safe Surgery Saves Lives program . We prospect ively collected data on clinical processes and outcomes from 3733 consecutively enrolled patients 16 years of age or older who were undergoing noncardiac surgery . We subsequently collected data on 3955 consecutively enrolled patients after the introduction of the Surgical Safety Checklist . The primary end point was the rate of complications , including death , during hospitalization within the first 30 days after the operation . RESULTS The rate of death was 1.5 % before the checklist was introduced and declined to 0.8 % afterward ( P=0.003 ) . Inpatient complications occurred in 11.0 % of patients at baseline and in 7.0 % after introduction of the checklist ( P<0.001 ) . CONCLUSIONS Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals 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 Prospect i ve r and omized 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 st and ard 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 st and ard treatment procedure for this patient group OBJECTIVES Little is known about the physiologic and clinical effects of noninvasive positive pressure ventilation ( NPPV ) in patients who have acute respiratory failure ( ARF ) after abdominal surgery . We evaluated our clinical experience with the use of NPPV in the treatment of ARF after abdominal surgery . METHODS We prospect ively evaluated NPPV use during a 2-year period in a medical-surgical ICU of a university hospital . We documented demographic and diagnostic data , gas exchange , and clinical outcomes . We compared patients who were not intubated to those who were intubated after a trial of NPPV . RESULTS Of 72 patients with ARF after abdominal surgery who were treated with NPPV , 48 patients avoided intubation ( 67 % ) . Patients in the intubated and nonintubated groups had similar demographic characteristics , and similar American Society of Anesthesiologists physical status and simplified acute physiology score II scores at admission . The intubated group had a significantly lower Pa(O2)/fraction of inspired oxygen ( Fi(O2 ) ) ratio ( 123 + /- 62 mm Hg vs 194 + /- 76 mm Hg , p < 0.01 ) and more extended bilateral alveolar infiltrates ( 67 % vs 31 % , p < 0.01 ) than the non-intubated group . Within the first NPPV observation period , the Pa(O2)/Fi(O2 ) increased ( + 36 + /- 29 % [ + /- SD ] , p = 0.04 ) and the respiratory rate decreased ( 28.2 + /- 3.4 breaths/min vs 23.1 + /- 3.8 breaths/min , p < 0.01 ) significantly only in the non-intubated group . The non-intubated group had significantly lower length of ICU stay ( 17.3 + /- 10.9 days vs 34.1 + /- 28.5 days , p < 0.01 ) and mortality rate ( 6 % vs 29 % , p < 0.01 ) . CONCLUSION NPPV may be an alternative to conventional ventilation in selected patients with ARF after abdominal surgery who require ventilatory support Background : Morbidly obese patients are at elevated risk of perioperative pulmonary complications , including airway obstruction and atelectasis . Continuous positive airway pressure may improve postoperative lung mechanics and reduce postoperative complications in patients undergoing abdominal surgery . Methods : Forty morbidly obese patients with known obstructive sleep apnea undergoing laproscopic bariatric surgery with st and ardized anesthesia care were r and omly assigned to receive continuous positive airway pressure via the Boussignac system immediately after extubation ( Boussignac group ) or supplemental oxygen ( st and ard care group ) . All subjects had continuous positive airway pressure initiated 30 min after extubation in the postanesthesia care unit via identical noninvasive ventilators . The primary outcome was the relative reduction in forced vital capacity from baseline to 24 h after extubation . Results : Forty patients were enrolled into the study , 20 into each group . There were no significant differences in baseline characteristics between the groups . The intervention predicted less reduction in all measured lung functions : forced expiratory volume in 1 s ( coefficient 0.37 , SE 0.13 , P = 0.003 , CI 0.13–0.62 ) , forced vital capacity ( coefficient 0.39 , SE 0.14 , P = 0.006 , CI 0.11–0.66 ) , and peak expiratory flow rate ( coefficient 0.82 , SE 0.31 , P = 0.008 , CI 0.21–0.1.4 ) . Conclusions : Administration of continuous positive airway pressure immediately after extubation maintains spirometric lung function at 24 h after laparoscopic bariatric surgery better than continuous positive airway pressure started in the postanesthesia care unit Gastroduodenitis should be included with duodenal ulcer and gastric ulcer in the spectrum of clinical disorders that have different pathogenetic mechanisms but a similar clinical picture . Published results of a clinical , endoscopic , radiologic , and histologic study of 100 patients presenting with gastrointestinal symptoms revealed that 61 % had classic and 39 % had atypical manifestations of peptic ulcer disease . We could not clinical ly distinguish the 24 patients with ulcer crater ( 40 % of the classic group ) from the 25 patients with acute gastroduodenitis without crater ( 41 % of the classic group ) . Preliminary data of a prospect i ve study compared the treatment responses of 19 patients with gastroduodenitis and 39 patients with peptic ulcer disease . These patients were diagnosed endoscopically and restudied after treatment with a bl and diet and antacids seven times per day for 8 weeks . The responses to therapy in gastroduodenitis and peptic ulcer were as follows : endoscopically , 63 and 80 % , respectively ; histologically , 74 and 65 % , respectively ; symptomatically , 47 and 65 % , respectively . Preliminary data on the duodenal epithelial thymidine uptake revealed an increased proliferative index in duodenitis patients but not in patients with peptic ulcer or control subjects Abstract . Background : The efficacy of nasal continuous positive airway pressure ( nCPAP ) as a prophylactic method for preventing cardiopulmonary complications after major vascular surgery has not been investigated . Patients / methods : In a prospect i ve r and omized trial , 204 patients undergoing elective midline laparotomy for vascular surgery were r and omized to receive st and ard therapy ( n=105 ) or additional prophylactic nCPAP ( n=99 ) for the first postoperative night . Postoperative oxygenation , incidence of severe cardiac , and pulmonary complications , length of intensive care surveillance and length of total postoperative hospital stay ( LOS ) were compared . Results : Prophylactic nCPAP significantly reduced the number of patients with severe oxygenation disturbances defined as paO2<70 mmHg with FiO2≥ 0.7 ( 5 versus 17 , P=.01 ) . There were no differences with respect to death , cardiac and pulmonary complications , length of intensive care surveillance or LOS . Conclusion : Prophylactic 12 h nCPAP significantly reduces the occurrence of postoperative oxygenation disturbances but has no effect on cardiac or pulmonary complications , need for intensive care , LOS or mortality after major vascular surgery Sixty-two patients undergoing elective abdominal surgery with a high operative risk and anesthesia by the ASA scale ( III/2 - 3 ) , and with a high index of cardiopulmonary risk after S. Epstein were examined . The study group comprised 31 patients who had undergone noninvasive ventilation ( NIV ) in the early postoperative period for preventive purpose s. In the control group ( n = 30 )  , moistened oxygen was insufflated after transition to spontaneous breathing . In patients with low functional reserves , the preventive use of NIV contributes to a rapider normalization of gas exchange , stabilization of hemodynamics , a reduction in the incidence of complications ( from 66.6 to 25.6 % ) and in the length of stay in an intensive care unit Twenty-four patients underwent elective cholecystectomy .  They were r and omized into two groups , one consisting of 13 patients having CPAP * by face-mask for 4 h after surgery and the other , consisting of 11 patients , serving as control . The patients were all given intravenous anesthesia and were manually ventilated during anesthesia without using PEEP . The groups were comparable as concerns sex , age , weight , smoking-habits , preoperative pulmonary status , type of surgery and anesthesia-time . The study showed that both groups had a reduction in VC and PaO2 and a high percentage of them developed chest X-ray changes . In none of the variables mentioned was there any significant difference between the groups after surgery . Hypoxemia after abdominal surgery can thus not be prevented by only using CPAP for 4 h postoperatively BACKGROUND AND PURPOSE Physiotherapists use a variety of techniques aim ed 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 r and omized 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 r and omly 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 STUDY OBJECTIVE Upper abdominal surgery results in a postoperative restrictive pulmonary syndrome . Bi-level positive airway pressure ( BiPAP System ; Respironics Inc ; Murrysville , Pa ) , which combines pressure support ventilation and positive end-expiratory pressure via a nasal mask , could allow alveolar recruitment during inspiration and prevent expiratory alveolar collapse , and therefore limit the postoperative pulmonary restrictive syndrome . This study investigated the effect of BiPAP on postoperative pulmonary function in obese patients after gastroplasty . DESIGN Prospect i ve controlled r and omized study . SETTING GI surgical ward in a university hospital . PATIENTS Thirty-three morbidly obese patients scheduled for gastroplasty were studied . INTERVENTION The patients were assigned to one of three techniques of ventilatory support during the first 24 h postoperatively : O2 via a face mask , BiPAP System 8/4 , with inspiratory and expiratory positive airway pressure set at 8 and 4 cm H2O , respectively , or BiPAP System 12/4 set at 12 and 4 cm H2O .  Pulmonary function ( FVC , FEV1 , and peak expiratory flow rate [ PEFR ] ) were measured the day before surgery , 24 h after surgery , and on days 2 and 3 . Oxygen saturation by pulse oximeter ( SpO2 ) was also recorded during room air breathing . RESULTS Three patients were excluded . After surgery , FVC , FEV1 , PEFR , and SpO2 significantly decreased in the three groups . On day 1 , FVC and FEV1 were significantly improved in the group BiPAP System 12/4 , as compared with no BiPAP ;  SpO2 was also significantly improved . After removal of BiPAP System 12/4 , these benefits were maintained , allowing faster recovery of pulmonary function . No significant effects were observed on PEFR . BiPAP System 8/4 had no significant effect on the postoperative pulmonary restrictive syndrome . CONCLUSION Prophylactic use of BiPAP System 12/4 during the first 24 h postoperatively significantly reduces pulmonary dysfunction after gastroplasty in obese patients and accelerates reestablishment of preoperative pulmonary function Postoperative pulmonary complications , alveolar-arteriolar oxygen difference ( [A-a]O2-diff ) , peak expiratory flow ( PEF ) and forced vital capacity ( FVC ) were compared in patients using continuous positive airway pressure ( CPAP ) and positive expiratory pressure ( PEP ) administered  by face mask  against those of a control  group using  a deep-breathing device ( Triflo ) .  Forty-three consecutive , r and omized patients undergoing elective upper abdominal surgery were included .  CPAP , PEP and Triflo were administered for 30 consecutive breaths in every waking hour for three days postoperatively . The (A-a)O2-difference increased equally and significantly in the three groups after surgery , reaching a maximum on the first postoperative day . After this day , however , (A-a)O2-diff decreased in the CPAP and PEP groups , being significantly lower in the PEP group compared to the control group , two days postoperatively ( p less than 0.05 ) and significantly lower in both the PEP and CPAP groups three days postoperatively ( p less than 0.001 and p less than 0.05 , respectively . ) PEF did not differ significantly between the groups before or after surgery , while FVC was significantly higher in the PEP and CPAP groups , compared to control , on the third postoperative day ( p less than 0.05 ) . Atelectatic consolidation was observed in six of 15 patients in the control group three days postoperatively , the incidence being significantly lower in both the PEP group ( 0 of 15 , p less than 0.001 ) and the CPAP group ( one of 13 , p less than 0.05 ) . We concluded that periodic face mask administration of CPAP and PEP are superior to deep breathing exercises with respect to gas exchange , preservation of lung volumes and development of atelectasis after upper abdominal surgery . We also conclude that the simple and commercially available PEP mask is as effective as the more complicated CPAP system CONTEXT Hypoxemia complicates the recovery of 30 % to 50 % of patients after abdominal surgery ; endotracheal intubation and mechanical ventilation may be required in 8 % to 10 % of cases , increasing morbidity and mortality and prolonging intensive care unit and hospital stay . OBJECTIVE To determine the effectiveness of continuous positive airway pressure compared with st and ard treatment in preventing the need for intubation and mechanical ventilation in patients who develop acute hypoxemia after elective major abdominal surgery . DESIGN AND SETTING R and omized , controlled , unblinded study with concealed allocation conducted between June 2002 and November 2003 at 15 intensive care units of the Piedmont Intensive Care Units Network in Italy . PATIENTS Consecutive patients who developed severe hypoxemia after major elective abdominal surgery . The trial was stopped for efficacy after 209 patients had been enrolled . INTERVENTIONS Patients were r and omly assigned to receive oxygen ( n = 104 ) or oxygen plus continuous positive airway pressure ( n = 105 ) . MAIN OUTCOME MEASURES The primary end point was incidence of endotracheal intubation ; secondary end points were intensive care unit and hospital lengths of stay , incidence of pneumonia , infection and sepsis , and hospital mortality . RESULTS Patients who received oxygen plus continuous positive airway pressure had a lower intubation rate ( 1 % vs 10 % ; P = .005 ; relative risk [ RR ] , 0.099 ; 95 % confidence interval [ CI ] , 0.01 - 0.76 ) and had a lower occurrence rate of pneumonia ( 2 % vs 10 % , RR , 0.19 ; 95 % CI , 0.04 - 0.88 ; P = .02 ) , infection ( 3 % vs 10 % , RR , 0.27 ; 95 % CI , 0.07 - 0.94 ; P = .03 ) , and sepsis ( 2 % vs 9 % ; RR , 0.22 ; 95 % CI , 0.04 - 0.99 ; P = .03 ) than did patients treated with oxygen alone . Patients who received oxygen plus continuous positive airway pressure also spent fewer mean ( SD ) days in the intensive care unit ( 1.4 [ 1.6 ] vs 2.6 [ 4.2 ] , P = .09 ) than patients treated with oxygen alone . The treatments did not affect the mean ( SD ) days that patients spent in the hospital ( 15 [ 13 ] vs 17 [ 15 ] , respectively ; P = .10 ) . None of those treated with oxygen plus continuous positive airway pressure died in the hospital while 3 deaths occurred among those treated with oxygen alone ( P = .12 ) . CONCLUSION Continuous positive airway pressure may decrease the incidence of endotracheal intubation and other severe complications in patients who develop hypoxemia after elective major abdominal surgery Background In the postoperative period hypoventilation and hypoxia with hypercarbia may occur in morbidly obese patients due to the residual influence of general anesthesia drugs , postoperative atelectasis and postoperative pain . Non-Invasive Ventilation ( NIV ) is a method of improvement of respiratory efficiency in patients not requiring mechanical ventilation . The aim of the study was to compare NIV ( Boussignac ) CPAP and traditional oxygen delivery via nasal catheter in the postoperative acute care unit ( PACU ) in morbidly obese patients after open Roux-en-Y gastric bypass ( RYGBP ) . Methods 19 morbidly obese patients scheduled for elective open RYGBP , were r and omly divided into 2 groups : CPAP ( 10 patients ) or control ( nasal catheter –9 patients ) . Patients consisted of : 8 male and 11 female , mean weight 127.76 ±–8.5 kg , height 173.41 ±–.41 cm , BMI 42.43 ±–.3 kg/m2 , age 35.84 ±–.05 years . In the PACU , capillary blood gas measurements were taken at 3 Time Points : T1 –30 min , T2 –4 hours and T3 –8 hours after admission . Sample T0 was taken before surgery . For management of postoperative pain , patients received morphine 2 mg/h intravenously and tramadol 100 mg . Results Mean blood gas measurements of all postoperative time points were : pO2 81.0 ±–6.0 ( range 78.1–5.7 ) mmHg vs 65.9 ±–.9 ( range 63.8–8.1 ) mmHg ( P – lt;–.05 ) ; pCO2 40.6 ±–.4 ( range 39.4–1.8 ) mmHg vs 41.5 ±–.0 ( range 39.6–3.4 ) mmHg ( P – gt;–.05 ) , in the CPAP and control groups respectively . In every case , pulse-oxymetry oxygenation was > 94 % . Conclusion Boussignac CPAP improved blood oxygenation compared to passive oxygenation with a nasal catheter but had no influence on CO2 elimination in non-CO2 retaining morbidly obese patients Objective To develop and vali date a preoperative risk index for predicting  postoperative respiratory failure ( PRF ) .  Summary Background Data Respiratory failure is an important postoperative complication . Method Based on a prospect i ve cohort study , cases from 44 Veterans Affairs Medical Centers ( n = 81,719 ) were used to develop the models . Cases from 132 Veterans Affairs Medical Centers ( n = 99,390 ) were used as a validation sample . PRF was defined as mechanical ventilation for more than 48 hours after surgery or reintubation and mechanical ventilation after postoperative extubation . Ventilator-dependent , comatose , do not resuscitate , and female patients were excluded . Results PRF developed in 2,746 patients ( 3.4 % ) . The respiratory failure risk index was developed from a simplified logistic regression model and included abdominal aortic aneurysm repair , thoracic surgery , neurosurgery , upper abdominal surgery , peripheral vascular surgery , neck surgery , emergency surgery , albumin level less than 30 g/L , blood urea nitrogen level more than 30 mg/dL , dependent functional status , chronic obstructive pulmonary disease , and age . Conclusions The respiratory failure risk index is a vali date d model for identifying patients at risk for developing PRF and may be useful for guiding perioperative respiratory care Continuous positive airway pressure ( CPAP ) is used to prevent apneic arrest and /or hypoxia in patients suffering from obstructive sleep apnea . This modality has not been universally accepted for patients following upper gastrointestinal surgery because of concerns that pressurized air will inflate the stomach and proximal intestine , result ing in anastomotic disruption . This study was performed to assess the safety and efficacy of postoperative CPAP for patients undergoing a gastrojejunostomy as part of a Roux-en-Y gastric bypass ( RYGB ) procedure . A total of 1067 patients ( 837 women [ 78 % ] and 230 men [ 22 % ] ) were prospect ively evaluated for the risk of developing anastomotic leaks and pulmonary complications after the RYGB procedure . Of the 1067 patients undergoing gastric bypass , 420 had obstructive sleep apnea and 159 were dependent on CPAP .  There were 15 major anastomotic leaks , two of which occurred in CPAP-treated patients . Contingency table analysis demonstrated that there was no correlation between CPAP utilization and the incidence of major anastomotic leakage ( P = 0.6 ) . Notably , no episodes of pneumonia were diagnosed in either group . Despite the theoretical risk of anastomotic injury from pressurized air delivered by CPAP , no anastomotic leaks occurred that were attributable to CPAP . There were no pulmonary complications in a patient population that is at risk for developing them postoperatively . CPAP is a useful modality for treating hypoventilation after RYGB without increasing the risk of developing postoperative anastomotic leaks Pulmonary complications are frequently seen after thoracoabdominal resection of the oesophagus . The aim of this study was to compare the effects of two different breathing exercise regimens applied in the immediate postoperative period on the risk of pulmonary insufficiency after thoracoabdominal resection The effect of three postoperative regimes of respiratory therapy on  pulmonary complications and lung function was compared in high‐risk patients . Fifty‐one patients were r and omized to : 1 ) conventional chest physiotherapy alone ( PHYS ) , 2 ) chest physiotherapy and positive expiratory pressure ( PEP ) , or 3 ) chest physiotherapy with both positive expiratory pressure and inspiratory resistance ( RMT ) . Treatments were given twice daily by a physiotherapist and self‐administered . The incidence of postoperative pulmonary complications ( PPC ) was respectively , 71 % , 76 % and 65 % in the PHYS‐ , PEP‐ and RMT‐groups . The incidence of PPC requiring treatment with antibiotic , bronchodilator or supplementary oxygen according to the existing clinical practice was 47 % , 47 % and 29 % . The incidence of atelectasis was 65 % , 64 % and 60 % and of pneumonia 29 % , 35 % and 6 % . There was no difference between the groups , except for a tendency to a lower frequency of pneumonia in the RMT‐group . Postoperatively forced vital capacity ( FVC ) decreased to mean 54 % , forced expired volume in 1 s to 48 % and functional residual capacity to 76 % of preoperative values . Arterial oxygen tension ( Pao2 ) declined to mean 8.1 kPa and arterial saturation ( Sao2 ) to 89 % . There was no difference between the groups except for FVC , Pao2 and Sao2 ( P = 0.008 , P = 0.008 and P = 0.002 ) , which showed the least decrease in the RMT‐group . None of the regimens could be considered as satisfactory concerning the prevention of PPC , but RMT seemed to be the most efficient . Insufficient self‐administration of treatment was probably one of the causes of the overall high incidence of PPC in this study Background After major surgery , analgesia with opioids can cause obstructive apnea and intermittent hypoxemia , probably from loss of upper airway control . Since this resembles the obstructive sleep apnea syndrome , we tested the possibility that nasal continuous positive airway pressure ( nCPAP ) would reduce episodes of reduced oxygen saturation and sleep disruption . Because oxygen therapy is frequent after surgery , we also assessed the effect of oxygen on sleep disruption . Methods We recruited 48 patients about to have major abdominal surgery . We present data for 34 patients : 27 who received patient-controlled intravenous morphine and 7 who received epidural opioid .  Treatment was r and omized to either nCPAP or conventional therapy with an oxygen mask . Alternate periods of administration of air and 35 % oxygen were used in both groups . If the oxygen saturation as measured by pulse oximetry was consistently < 90 % on air , the patient was withdrawn from the study . We measured sleep , arousals , oxygenation , episodes of desaturation , and disturbances of respiration . Values are given as median and quartiles . Results The median proportion of time awake was 65 % ( 45–79 % ) among control patients and 74 % ( 55–87 % ) among those undergoing nCPAP . Oxygen administration did not affect the sleep pattern . The median frequency of arousals per hour of sleep was very similar in each group : during air breathing from nCPAP , 125 ( 76–187 ) , and during air breathing by mask , 116 ( 84–187 ) . Oxygen therapy had no effect . Oxygenation and hypoxemic events were not improved by nCPAP . Oxygen therapy improved oxygenation and reduced but did not eliminate episodes of desaturation . Conclusions Nasal CPAP does not improve sleep and oxygenation or reduce hypoxemic events in the first night after major abdominal surgery Controversy exists regarding the routine use of aids to lung expansion in the prevention of pulmonary complications after abdominal surgery . We prospect ively r and omized 172 patients into 1 of 4 groups : the  control group ( 44 patients ) received no respiratory treatment  , the IPPB  group ( 45 patients ) received intermittent positive pressure breathing therapy for 15 min 4 times daily , the IS group ( 42 patients ) was treated with incentive spirometry 4 times daily , and the DBE group ( 41 patients ) carried out deep breathing exercises under supervision for 15 min 4 times daily . Roentgenographic changes , observed 24 h after surgery , were comparable in the 4 groups ( 20.5 to 36.6 % ) . Pulmonary complications were defined as the development of 3 or more of 6 new findings : cough , phlegm , dyspnea , chest pain , temperature greater than 38 degrees C , pulse rate more than 100 beats/min . The frequency of development of pulmonary complications was 48 % in the control group , 22 % in the IPPB group ( p less than 0.05 ) , 21 % in the IS group ( p less than 0.05 ) , and 22 % in the DBE group ( p less than 0.05 ) . Side effects of respiratory treatment were observed only in the IPPB group ( 18 % ; p less than 0.05 ) . Hospital stay in patients undergoing upper abdominal surgery was significantly shorter in the IS group ( mean + /- SD , 8.6 + /- 3 days ) than in the control group ( 13 + /- 5 days ) . This difference was not observed for the other 2 treatment groups . ( ABSTRACT TRUNCATED AT 250 WORDS Two hundred and seventeen patients undergoing digestive tract surgery , either r and omly or non-r and omly allocated in two separate groups , and presenting postoperative hypoxemia , were studied during intensive care : 77 were ventilated by continuous positive pressure ( CPP ) , 70 by intermittent positive pressure ( IPP ) , and 70 were treated by classical respiratory physiotherapy . Results showed that CPP was the method of choice for ventilatory assistance following digestive tract surgery : hematosis was improved in a prolonged manner without modification of CO2 levels . The other procedures had a beneficial effect on PaO2 but at the price of a hyperventilation .  Patients receiving IPP developed hypocapnea and hypoxemia five minutes after the end of the treatment . Physiopathological bases for these differences in gasometric behaviour in patients undergoing digestive tract surgery are analyzed as a function of the characteristics of CPP on the one h and , and IPP and respiratory physiotherapy on the other The problem of how to improve postoperative pulmonary function after upper abdominal surgery was investigated in a r and omized study involving 64 patients who were subjected to various treatment regimens design ed to increase airway pressure .  Intraoperative ventilation was carried out with either zero or positive end exspiratory pressure , and postoperatively either CPAP or a nasal oxygen catheter were applied . The following groups were formed : 1 . ZEEP /O2-catheter ; 2 . PEEP/O2-catheter ; 3 . ZEEP /CPAP ; 4 . PEEP/CPAP . The typical reduction in vital capacity occurred postoperatively , the lowest value being recorded on the 2nd postoperative day , an alteration in respiratory pattern with reduced tidal volume and increased respiratory rate together with an initially low , later normal alveolar ventilation , and an initial hypoxaemia which was at first associated with a moderate hypercapnia , on the second postoperative day with a normocapnia , were observed . At no point in time could a difference be found between the 4 groups , no measurable improvement in respiratory function being found as a result of the treatment given . Intra- and post-operative increase in airway pressure was however found to be associated with a reduction in the incidence of post-operative pulmonary complications Abstract After intubation for elective upper abdominal surgery 30 patients were r and omized in group A or B. Both groups had the same anaesthetics and were ventilated with a tidal volume of 12 ml/kg the rate keeping PaCO2 near 40 mm Hg . Group A was ventilated with ZEEP and group B with PEEP 10 cm H2O . Group A was extubated when VC reached 15 ml/kg and PaCO2 did not exceed 50 mm Hg breathing spontaneously . Group B was allowed to breathe spontaneously with CPAP and PEEP 5 cm H2O ( Basel PEEP-WeanerR ) for 3 hours before extubation . Measurements : BP , PAP , RAP , HR , Hb , arterial and mixed-venous blood gases with FIO2=0,21 . Both groups were similar in age , sex , cigarette consumption , preoperative pulmonary pathology , surgical procedure pathology , surgical procedure and time of operation . Results : RAP , PAP , BP , HR , PaCO2 , PaH , Pv−O2 did not show important differences . Mean PaO2 changed as follows : Postoperative chest X-rays showed in Group A a total of 56 negative scores , in Group B 25 . Conclusion : After upper abdominal surgery the well known decrease of FRC with its increased venous admixture can be prevented if the patient is ventilated with PEEP during operation and is breathing spontaneously with CPAP and PEEP for 3 postoperative hours before extubation STUDY OBJECTIVE To examine the efficacy of a nasal continuous positive airway pressure ( CPAP ) system for respiratory support in patients who have respiratory insufficiency but are able to maintain spontaneous breathing without hypercapnia , respiratory acidosis , or deteriorated mental status . DESIGN Prospect i ve study . SETTING Medical and surgical patients admitted to the intensive care unit ( ICU ) at the Hillel Yaffe Medical Center . PATIENTS Nineteen patients with acute respiratory insufficiency and intact mental status who were able to maintain spontaneous breathing without hypercapnia or respiratory acidosis . Additional entry criteria were as follows : arterial oxygen tension ( PaO2 ) less than 65 mmHg on inspired oxygen tension ( FIO2 ) greater than or equal to 0.45 , PaO2/FIO2 less than 150 , respiratory rate greater than 35 breaths/minute , and inability to tolerate mask CPAP . INTERVENTIONS Nasal CPAP ( 10 cmH2O ) was applied to patients through two nasopharyngeal airways with an internal diameter ( ID ) of 8 mm each , inserted in both nostrils . During CPAP application , the patients were requested to breathe through their nose with their mouth closed . Even if they breathed through their open mouth , however , CPAP was maintained despite an observed pressure decrease of 4 cmH2O . MEASUREMENTS AND MAIN RESULTS All patients showed a constant improvement in arterial blood gases , PaO2/FIO2 , and respiratory signs during nasal CPAP of 10 cmH2O . PaO2 increased from 52 + /- 5.3 mmHg to 131 + /- 20 mmHg with CPAP administration ( p less than 0.05 ) , while arterial carbon dioxide tension ( PaCO2 ) increased from 32 + /- 2 mmHg to 36 + /- 2 mmHg ( p less than 0.05 ) and respiratory rate decreased from 39 + /- 2.3 breaths/minute to 31 + /- 1.6 breaths/minute ( p less than 0.05 ) . CONCLUSIONS Nasal CPAP ( 10 cmH2O ) is a reliable alternative to support arterial oxygenation in patients with respiratory failure who are alert and vigorous enough to avoid hypercapnia and respiratory acidosis while breathing spontaneously . In addition , since the patients are able to speak and thus are capable of expressing their feelings , the anxiety observed during respiratory support can be reduced The severely obese patient has varying degrees of intrinsic reduction of expiratory flow rates and lung volumes . Thus , the severely obese patient is predisposed to postoperative atelectasis , ineffective clearing of respiratory secretions , and other pulmonary complications . This study evaluated the effect of bi-level positive airway pressure ( BiPAP ) on pulmonary function in obese patients following open gastric bypass surgery Patients with a body mass index ( BMI ) of at least 40 kg/m2 who were undergoing elective gastric bypass were eligible to be r and omized to receive either BiPAP during the first 24 h postoperatively or conventional postoperative care .  Patients with significant cardiovascular and pulmonary diseases were excluded from the study .  Forced vital capacity ( FVC ) , forced expiratory volume in 1 s ( FEV1.0 ) , peak expiratory flow rate ( PEFR ) , and percent hemoglobin oxygen saturation ( SpO2 ) were measured preoperatively , and on postoperative days 1 , 2 , and 3 . Twenty-seven patients were entered in the study 14 received BiPAP and 13 received conventional postoperative care . There was no significant difference preoperatively between the study and control groups in regards to age , BMI , FVC , FEV1.0 , PEFR or SpO2 . Postoperatively expiratory flow was decreased in both groups . However , the FVC and FEV1.0 were significantly higher on each of the three consecutive postoperative days in the patients who received BiPAP therapy . The SpO2 was significantly decreased in the control group over the same time period . Prophylactic BiPAP during the first 12 - 24 h postoperatively result ed in significantly higher measures of pulmonary function in severely obese patients who had undergone elective gastric bypass surgery . These improved measures of pulmonary function , however , did not translate into fewer hospital days or a lower complication rate in our study population of otherwise healthy obese patients . Further study is necessary to determine if BiPAP therapy in the first 24 postoperative hours would be of benefit in severely obese patients with comorbid illnesses who have undergone elective gastric bypass BACKGROUND Postoperative hypoxemia is a common complication in the anesthesia recovery room ( ARR ) , which is predominantly based on the development of atelectasis , excessive intraoperative fluid shift and insufficient ventilation . The goal of this prospect i ve observational study was to compare the effect of st and ard oxygen administration via a face mask with oxygen administration using the EzPAP ® system , a device which additionally provides a positive end-expiratory pressure ( PEEP ) . METHODS This study included 210 patients with postoperative hypoxemia ( S(p)O(2 ) < 93 % ) subdivided into the control group ( 105 patients ) and the EzPAP group ( 105 patients ) . Postoperative residual paralysis was excluded using relaxometry and a train of four ( TOF ) ratio of 0.9 was assumed to ensure sufficient recovery of respiratory function from neuromuscular blockade . Patients who received a reversal of neuromuscular blockade were excluded . In cases of hypoxemia ( S(p)O(2 ) < 93 % ) control patients were treated with oxygen ( 6 l/min ) using a face mask , whereas the EzPAP group received oxygen using the EzPAP ® system . In order to adjust the PEEP in the EzPAP group , the O(2 ) flow was verified and measured by a manometer . After 1 h of oxygen therapy , the oxygen supply was stopped . In cases of reoccurring hypoxemia ( S(p)O(2 ) < 93 % , persistence > 5 min ) , the oxygen therapy was restarted in both groups via a facemask . Both groups were compared using repeat measurement analysis of variance ( ANOVA ) , the unpaired t-test , the Mann-Whitney U-test , Fisher 's exact test and the χ(2)-test . The correlation of O(2 ) flow and PEEP was evaluated by regression analysis and p < 0.05 was considered to be statistically significant . Apart from this a subgroup analysis was performed depending on body-mass index ( BMI ) , American Society of Anesthesiologists ( ASA ) classification , intraoperative airway management , the use of neuromuscular blocking agents and co-existing disorders , e.g. chronic obstructive lung disease ( COLD ) , obesity and chronic heart failure . RESULTS All patients were equally distributed between both groups with respect to demographic data , ASA classification , BMI , co-existing disorders and surgical procedures . The S(p)O(2 ) values did not differ between the EzPAP patients and the control group , except for 0.5 min after initiation of oxygen therapy : EzPAP group 96 ± 3.7 % ( mean ± st and ard deviation ) versus the control group 93.8 ± 4.4 % ( p < 0.001 ) . However , restarting oxygen therapy was less common in the EzPAP group ( EzPAP group 25 versus control group 41 , p = 0.03 ) , as well as the occurrence of postoperative complications  ( EzPAP group 13 versus control group 25 , p = 0.02 ) , e.g. nosocomial pneumonia ( 0 versus 4 ) and wound infections ( 2 versus 3 ) . Furthermore , patients with obesity and pulmonary disorders , such as COLD had a benefit from oxygen administration using the EzPAP device and showed higher postoperative than preoperative S(p)O(2 ) values . In contrast , the subgroup analysis of patients with heart failure did not reveal any differences between both groups and both groups did not differ in terms of time spent in the recovery room  ( EzPAP group 113 min versus control group 174.8 min , p = 0.2 ) . CONCLUSIONS In this observational study oxygen supply using the EzPAP ® system appeared to be at least equally as effective in the therapy of postoperative hypoxemia compared to st and ard oxygen supply using a face mask . In patients with a high risk of postoperative hypoxemia , such as patients with obesity and /or pulmonary disorders , oxygen administration using the EzPAP ® system possibly improves pulmonary oxygenation more effectively and is longer lasting compared to st and ard oxygen supply via a face mask . Hence , the EzPAP ® system represents a well-tolerated , effective , cost-effective and easily operated tool to improve postoperative oxygenation . In order to investigate the possibilities of this promising tool more intensively , r and omized clinical trials are warranted Purpose This study compared the Boussignac ™ continuous positive airway pressure ( CPAP ) mask with the venturi face mask in terms of the postoperative PaO2/FiO2 ( PF ) ratio in morbidly obese patients after bariatric surgery . Methods Following hospital Research Ethics Board approval and written informed consent , morbidly obese ( body mass index > 35 kg·m−2 ) patients undergoing bariatric surgery were recruited . The patients were anesthetized and laparoscopic Roux-en-Y gastric bypass was performed . Patients were assigned r and omly to receive either the Boussignac ( Boussignac Group ) or the venturi face mask ( Venturi Group ) immediately after tracheal extubation . Patients were transported to the postanesthesia care unit , and the respective devices were applied for one hour . The PF ratio was recorded after tracheal intubation and at one hour and two hours post extubation . The percent forced expiratory volume ( % FEV1 ) and the percent forced vital capacity ( % FVC ) were recorded preoperatively and at one hour and two hours post extubation . Independent Student ’s t tests were used for continuous variables , and the Chi square test was used for categorical variables . P < 0.05 was considered statistically significant . Results Eighty-one patients ( Group Boussignac , n = 43 ; Group Venturi , n = 38 ) completed the study . Mean ages and body mass indices were similar in the two groups . At one hour post extubation , the PF ratio in the Boussignac Group was 361 ( 170 ) compared with 279 ( 91 ) in the Venturi Group ( P = 0.007 ) , and at two hours post extubation , the PF ratio in the Boussignac Group was 371 ( 162 ) compared with 323 ( 127 ) in the Venturi Group ( P = 0.1 ) . The postoperative % FEV1 and % FVC were comparable in both groups at all time points . Conclusion Compared with the venturi mask , the Boussignac CPAP mask improves the postoperative PF ratio in morbidly obese patients after bariatric surgery .  The postoperative % FEV1 and % FVC are comparable for both groups . RésuméObjectifCette étude a comparé le masque de ventilation à pression positive continue ( VPPC ) Boussignac ™ au masque facial Venturi en termes du ratio de PaO2/FiO2 ( PF ) postopératoire chez les patients obèses morbides après une chirurgie bariatrique . MéthodeAprès avoir obtenu le consentement du Comité d’éthique de la recherche de l’hôpital et le consentement éclairé par écrit des patients , nous avons recruté des patients obèses morbides ( indice de masse corporelle > 35 kg·m−2 ) subissant une chirurgie bariatrique . Les patients ont été anesthésiés et une dérivation gastrique de Roux-en-Y par laparoscopie a été réalisée . Les patients ont été r and omisés  soit au masque Boussignac ( groupe Boussignac ) , soit au masque facial Venturi ( groupe Venturi ) immédiatement après l’extubation trachéale . Les patients ont été transportés en salle de réveil , et les masques respectifs ont été appliqués pendant une heure . Le ratio PF a été enregistré après l’intubation trachéale , puis une heure et deux heures après l’extubation . Le pourcentage du volume expiratoire maximal seconde ( % VEMS ) et le pourcentage de capacité vitale forcée ( % FVC ) ont été enregistrés avant l’opération , puis une heure et deux heures après l’extubation . Des tests t de Student indépendants ont été utilisés pour mesurer les variables continues , et le test du Chi carré a été utilisé pour les variables catégoriques . Une valeur P < 0,05 a été considérée comme étant statistiquement significative . RésultatsQuatre-vingt-un patients ( groupe Boussignac , n = 43 ; groupe Venturi , n = 38 ) ont terminé l’étude . Les indices de masse corporelle et âges moyens étaient semblables dans les deux groupes . Une heure après l’extubation , le ratio PF dans le groupe Boussignac était de 361 ( 170 ) par rapport à 279 ( 91 ) dans le groupe Venturi ( P = 0,007 ) , et deux heures après l’extubation , le ratio PF était de 371 ( 162 ) dans le groupe Boussignac par rapport à 323 ( 127 ) dans le groupe Venturi ( P = 0,1 ) . Les % VEMS et % FVC postopératoires étaient comparables dans les deux groupes à tous les temps de mesure . Conclusion Par rapport au masque Venturi , le masque de VPPC de Boussignac améliore le ratio PF postopératoire chez les patients obèses morbides après une chirurgie bariatrique . Les % VEMS et % FVC postopératoires sont comparables dans les deux groupes
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 st and ard care  , which may include traditional oxygen delivery systems , physiotherapy and incentive spirometry .