Noninvasive ventilatory support after lung resectional surgery. Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Comparison of gas exchange after lung resection with a Boussignac CPAP or Venturi mask. Three different mask physiotherapy regimens for prevention of post-operative pulmonary complications after heart and pulmonary surgery [The place of routine immediate non-invasive ventilation following pulmonary resection in preventing pulmonary complications in patients with COPD (POPVNI Trial)]. Prophylactic use of noninvasive ventilation in patients undergoing lung resectional surgery. CPAP Increases 6-Minute Walk Distance After Lung Resection Surgery Intermittent positive-pressure breathing after lung surgery Prophylactic Use of Helmet CPAP After Pulmonary Lobectomy: A Prospective Randomized Controlled Study Continuous positive airway pressure (CPAP) after lung resection: a randomized clinical trial. A randomized, prospective evaluation of noninvasive ventilation for acute respiratory failure.
STUDY OBJECTIVES To investigate the short-term effects of noninvasive ventilatory support ( NIVS ) on pulmonary gas exchange , ventilatory pattern , systemic hemodynamics , and pleural air leaks in patients su bmi tted to elective lung resection . DESIGN Prospect i ve , r and omized , parallel , and controlled investigation . SETTING Thoracic Surgery Unit , Hospital Universitari Son Dureta , Palma Mallorca , Spain . PATIENTS Nineteen patients electively su bmi tted to lung resection because of varied clinical reasons . INTERVENTIONS Medical therapy was st and ardized for all patients . Ten subjects received NIVS with a nasal ventilatory support system ( BiPAP ) during 1 h ( study group ) . The remaining nine individuals constituted the control group . MEASUREMENTS AND RESULTS Arterial blood gases , ventilatory pattern , systemic hemodynamics , and pleural air leaks were measured . Before surgery , there were no significant clinical or functional differences between groups . After surgery , and compared with preoperative measures , PaO2 decreased significantly ( p<0.01 ) and to the same extent both in the study group ( 85.7+/-2.8 to 68.0+/-2.7 mm Hg ) and the control group ( 83.6+/-2.5 to 67.3+/-2.6 mm Hg ) . In the study group , NIVS increased PaO2 ( to 76.7+/-3.0 mm Hg ; p<0.05 ) and decreased alveolar to arterial oxygen pressure gradient ( P[A-a]O2 ) ( 27.2+/-2.7 to 17.6+/-2.3 mm Hg ; p<0.05 ) . This latter effect was still present 1 h after withdrawing NIVS . By contrast , PaO2 and P(A-a)O2 remained unchanged in the control group throughout the study . PaCO2 , the ventilatory pattern , and systemic hemodynamics did not change significantly throughout the study in any group . Importantly , NIVS did not increase dead space to tidal volume ratio or worsen pleural air leaks . CONCLUSIONS Short-term NIVS with a ventilatory support system improves the efficiency of the lung as a gas exchanger without noticeable nondesired side effects in patients su bmi tted to lung resectional surgery When treated with invasive endotracheal mechanical ventilation ( ETMV ) , acute respiratory insufficiency after lung resection is fatal in up to 80 % of cases . Noninvasive positive-pressure ventilation ( NPPV ) may reduce the need for ETMV , thereby improving survival . We conducted a r and omized prospect i ve trial to compare st and ard therapy with and without nasal-mask NPPV in patients with acute hypoxemic respiratory insufficiency after lung resection . The primary outcome variable was the need for ETMV and the secondary outcome variables were in-hospital and 120-d mortality rates , duration of stay in the intensive care unit , and duration of in-hospital stay . Twelve of the 24 patients ( 50 % ) r and omly assigned to the no-NPPV group required ETMV , versus only five of the 24 patients ( 20.8 % ) in the NPPV group ( p = 0.035 ) . Nine patients in the no-NPPV group died ( 37.5 % ) , and three ( 12.5 % ) patients in the NPPV group died ( p = 0.045 ) . The other secondary outcomes were similar in the two groups . NPPV is safe and effective in reducing the need for ETMV and improving survival after lung resection BACKGROUND Postoperative continuous positive airway pressure ( CPAP ) can improve lung function . The aim of our study was to assess the efficacy of prophylactic CPAP on the Pa(O2)/FI(O2 ) ratio measured the day after surgery in patients undergoing lung resection surgery ( LRS ) . METHODS The study population comprised 110 patients undergoing LRS . On arrival in the postanaesthesia care unit ( PACU ) , patients were r and omized to receive CPAP at 5 - 7 cm H2O during the first 6 h after surgery ( CPAP group ) or supplemental oxygen through a Venturi mask ( Venturi group ) . The Pa(O2)/FI(O2 ) ratio was measured on arrival in the PACU , 7 h after admission , and the day after surgery . The Pa(O2)/FI(O2 ) ratio is the primary endpoint of our study . We also analysed the chest radiograph and assessed the postoperative course . We then analysed the impact of ventilatory management in the PACU depending on the respiratory risk of the patient . RESULTS Baseline characteristics were similar in both groups . Patients who received CPAP had significantly higher Pa(O2)/FI(O2 ) at 24 h after surgery compared with patients managed conventionally ( Venturi group ) ( 48.6±14 vs 42.3±12 , P=0.031 ) , but there were no differences at 7 h. On subgroup analysis , we found that the benefits of CPAP were greater in higher risk patients . The incidence of postoperative pulmonary complications and stay in the PACU and hospital were similar in both groups . CONCLUSIONS In patients undergoing LRS , prophylactic CPAP during the first 6 h after surgery with a pressure of 5 - 7 cm H2O improved the Pa(O2)/FI(O2 ) ratio at 24 h. This effect was more evident in patients with increased risk of postoperative pulmonary complications Objective An investigation into the incidence of post-operative complications after thoracic surgery with  3 different physiotherapy masks . Design A prospect i ve , consecutive , r and omized comparison . Setting Department of Thoracic and Heart Surgery at a University Hospital . The treatments were performed by experienced and specially trained physiotherapists . Patients 160 patients were evaluated . 60 patients undergoing heart surgery , 59 patients having pulmonary resection , and 41 patients with exploratory thoractomy . Interventions In each operative category the patients were treated with one of three face mask systems used in addition to routine chest physiotherapy . These were either continuous positive airway pressure ( CPAP ) , positive expiratory pressure ( PEP ) , or inspiratory resistance — positive expiratory pressure ( IR-PEP ) . Measurements and results Post-operative pulmonary complications were assessed by forced vital capacity ( FVC ) , arterial oxygen tension ( PaO2 ) , and chest X-ray examination , all measured pre-operatively and on the fourth and ninth post-operative day . The patients filled in a question naire expressing their opinion about their mask treatment . There was an equal decrease in FVC , FVC% , and PaO2 , and equal frequency of atelectasis in the 3 mask treatments . More patients with the PEP mask favoured their system than did those with the other 2 systems . Conclusion There was no statistically significant difference between the treatments : continuous positive airway pressure ( CPAP ) , positive expiratory pressure ( PEP ) , and inspiratory resistance — positive expiratory pressure ( IR-PEP ) on post-operative complications . Any of the three treatments may be used as supplement to st and ard chest physiotherapy BACKGROUND Respiratory complications are common following pulmonary resection and cause a significant mortality . The use of non-invasive ventilation ( NIV ) in acute respiratory insufficiency ( ARI ) is now well recognised . The prophylactic use of NIV in the absence of ARI and /or hypercapnia may be equally justified for the physiological benefits expected in the post-operative period following pulmonary surgery . The aim of our study therefore is to evaluate the effectiveness of  NIV in the prevention of pulmonary complications in the immediate post-operative care of patients with moderate and severe COPD . METHODS It will be a multicentre , prospect i ve , r and omised , parallel , open ended study of patients with moderate and severe COPD admitted to hospital for pulmonary resection . EXPECTED RESULTS To determine whether the setting up of NIV immediately post-operatively reduces the incidence of acute respiratory events ( acute respiratory insufficiency ) and to identify any sub-groups who receive greater benefit from NIV . This study should establish the place of NIV in the immediate post operative care following pulmonary resection QUESTION OF THE STUDY We studied whether prophylactic use of noninvasive pressure support ventilation ( NIPSV ) administered pre- and postoperatively may reduce the postoperative pulmonary function impairment . PATIENTS AND METHODS Prospect i ve r and omized clinical trial . Thirty-nine patients with a preoperative FEV(1 ) < 70 % of the predicted value scheduled for elective lobectomy related to lung cancer were enrolled . Seven patients were excluded after enrollment . Patients were required to follow st and ard treatment without ( control group , n=18 ) or with NIPSV ( study group , n=14 ) during 7 days at home before surgery , and during 3 days postoperatively . Primary outcome variable was the changes on arterial blood gases on room air . RESULTS Two hours after surgery , PaO(2 ) , FVC and FEV(1 ) values were significantly better in the NIPSV group . On day 1 , 2 and 3 , PaO(2 ) was significantly improved in the NIPSV group . Also on day 1 , FVC and FEV(1 ) improved significantly in the NIPSV group . The hospital stay was significantly longer in the control group than in the study group ( p=0.04 ) . The incidence of major atelectasis was 14.2 % in the NIPSV group and 38.9 % in the no-NIPSV group ( p=0.15 ) . ANSWER TO THE QUESTION : Prophylactic use of NIPSV in a pre- and postoperative manner significantly reduces pulmonary dysfunction after lung resection . As a result , recovery of preoperative respiratory function is accelerated BACKGROUND : The application of CPAP has been used to minimize postoperative pulmonary complications after lung resection surgery . The aim of this study was to quantify both the CPAP effects upon lung function and functional capacity in early postoperative lung resection , as well as to evaluate if CPAP prolongs air leak through the chest drain . METHODS : Thirty patients in the postoperative period of lung resection were allocated into 2 groups : an experimental group , consisting of 15 patients who underwent a 10 cm H2O CPAP  , and a  15 patient control group  , who performed breathing exercises . Arterial blood gas analysis , peak expiratory flow ( PEF ) , respiratory muscle strength , spirometry , and 6-min walk test ( 6MWT ) were assessed in the preoperative period , and repeated postoperatively on the first and on the seventh day ( 6MWT was repeated only on the seventh day ) . RESULTS : Significant increases in PEF , muscle strength , and FEV1 between the first and seventh postoperative day were observed , both in the experimental and in the control group , whereas FVC and PaO2 increased significantly between the first and seventh postoperative day only in the experimental group . The average loss in 6-min walk distance ( 6MWD ) from preoperative to postoperative day 7 in the experimental group was significantly lower than in control group . When comparing the 2 groups , only 6MWD was statistically different ( P < .001 ) . There was no air leakage increase through the drain with the early use of CPAP . CONCLUSION : When compared to breathing exercises , CPAP increases the 6MWD in postoperative lung resection patients , without prolonging air leak through the chest drain Intermittent positive-pressure breathing is thought to avoid atelectasis and improve pulmonary function after major lung resections . Since no clear scientific data was available to confirm this , our objective was to determine whether atelectasis can be avoided and if postoperative lung function is improved . Prospect i ve analysis was carried out in 135 patients operated on between 2007 and 2009 ; 55 received intermittent positive-pressure breathing .  Pre- and postoperative lung function tests were similar in both groups .  Pulmonary complications were observed in 19 % of patients without intermittent positive-pressure breathing and 27 % of those who received this treatment . We were unable to find evidence that additional improvement in postoperative pulmonary function is achieved when adding intermittent positive-pressure breathing to the st and ard physical therapy BACKGROUND : Patients undergoing pulmonary lobectomy carry a high risk of respiratory complications after surgery . The postoperative prophylactic treatment with helmet CPAP may prevent postoperative acute respiratory failure and improve the PaO2/FIO2 . METHODS : We r and omly allocated 50 subjects to receive continuous oxygen therapy ( air-entrainment mask , FIO2 0.4 ) or 2 cycles of helmet CPAP for 120 min , alternating with analog oxygen therapy for 4 hours . Blood gas values were collected at admission to ICU , after 1 , 3 , 7 , 9 , 24 hours , and then in the thoracic ward after 48 hours and one week after surgery . We investigated the incidence of postoperative complications , mortality , and length of hospital stay . RESULTS : At the end of the second helmet CPAP treatment , the subjects had a significantly higher PaO2/FIO2 , compared with the control group ( 366 ± 106 mm Hg vs 259 ± 60 mm Hg , P = .004 ) , but the improvement in oxygenation did not continue beyond 24 hours . The postoperative preventive helmet CPAP treatment was associated with a significantly shorter hospital stay , in comparison to st and ard treatment ( 7 ± 4 d and 8 ± 13 d , respectively , P = .042 ) . The number of minor or major postoperative complications was similar between the 2 groups . No difference in ICU readmission or mortality was observed . CONCLUSIONS : The prophylactic use of helmet CPAP  improved the PaO2/FIO2 , but the oxygenation benefit was not lasting . In our study , helmet CPAP was a secure and well tolerated method in subjects who underwent pulmonary lobectomy . It might be safely applied whenever necessary CONTEXT AND OBJECTIVE Noninvasive mechanical ventilation during the postoperative period ( PO ) following lung resection can restore residual functional capacity , improve oxygenation and spare the inspiratory muscles . The objective of this study was to assess the efficacy of continuous positive airway pressure ( CPAP ) associated with physiotherapy , compared with physiotherapy alone after lung resection . DESIGN AND SETTING Open r and omized clinical trial conducted in the clinical hospital of Universidade Estadual de Campinas . METHOD Sessions were held in the immediate postoperative period ( POi ) and on the first and second postoperative days ( PO1 and PO2 ) , and the patients were reassessed on the discharge day . CPAP was applied for two hours and the pressure adjustment was set between 7 and 8.5 cmH2O . The oxygenation index ( OI ) , Borg scale , pain scale and presence of thoracic drains and air losses were evaluated . RESULTS There was a significant increase in the OI in the CPAP group in the POi compared to the Chest Physiotherapy ( CP ) group , P = 0.024 . In the CP group the OI was significantly lower on PO1 ( P = 0,042 ) , than CPAP group . The air losses were significantly greater in the CPAP group in the POi and on PO1 ( P = 0.001 , P = 0.028 ) , but there was no significant difference between the groups on PO2 and PO3 . There was a statistically significant difference between the groups regarding the Borg scale in the POi ( P < 0.001 ) , but there were no statistically significant differences between the groups regarding the pain score . CONCLUSION CPAP after lung resection is safe and improves oxygenation , without increasing the air losses through the drains . CLINICAL TRIAL REGISTRATION NCT01285648 We compared noninvasive positive-pressure ventilation ( NPPV ) , using bilevel positive airway pressure , with usual medical care ( UMC ) in the therapy of patients with acute respiratory failure ( ARF ) in a prospect i ve , r and omized trial . Patients were subgrouped according to the disease leading to ARF ( chronic obstructive pulmonary disease [ COPD ] , a non- COPD -related pulmonary process , neuromuscular disease , and status postextubation ) , and were then r and omized to NPPV or UMC .  Thirty-two patients were evaluated in the NPPV group and 29 in the UMC group . The rate of endotracheal intubation ( ETI ) was significantly lower in the NPPV than in the UMC group ( 6.38 intubations versus 21.25 intubations per 100 ICU days , p = 0.002 ) . Mortality rates in the intensive care unit ( ICU ) were similar for the two treatment groups ( 2.39 deaths versus 4.27 deaths per 100 ICU days , p = 0.21 , NPPV versus UMC , respectively ) . Patients with hypoxemic ARF in the  NPPV  group had a significantly lower ETI rate than those in the UMC group ( 7.46 intubations versus 22.64 intubations per 100 ICU days , p = 0.026 ) ; a similar trend was noted for patients with hypercapnic ARF ( 5.41 intubations versus 18.52 intubations per 100 ICU days , p = 0.064 , NPPV versus UMC , respectively ) . Patients with ARF in the non- COPD category had a lower rate of ETI with NPPV than with UMC ( 8.45 intubations versus 30.30 intubations per 100 ICU days , p = 0.01 ) . Although the rate of ETI was lower among COPD patients receiving NPPV , this trend did not reach statistical significance ( 5.26 intubations versus 15.63 intubations per 100 ICU days , p = 0.12 , NPPV versus UMC , respectively ) . In conclusion , NPPV with bilevel positive airway pressure reduces the rate of ETI in patients with ARF of various etiologies
BACKGROUND Pulmonary complications are often observed during the postoperative period of lung resection for patients with lung cancer .
Some conditions such as intubation , a long stay in the intensive care unit , the high cost of antibiotics and mortality may be avoided with the prevention of postoperative pulmonary complications .
Non-invasive positive pressure ventilation ( NIPPV ) is widely accepted and often used in hospitals , and may reduce the number of pulmonary complications and mortality after this type of surgery .
Therefore , a systematic review is required to map and critically assess the benefits and harms of NIPPV for patients undergoing lung resection .
OBJECTIVES To assess the efficacy and safety of NIPPV for preventing complications in patients who underwent pulmonary resection for lung cancer .