Non-Invasive Preventive Ventilation With Two Pressure Levels in the Postoperative Period of Roux-en-Y Gastric Bypass: Randomized Trial

Cavalcanti, Mabelle Gomes de Oliveira; Andrade, Lívia Barboza de; Santos, Patrícia Clara Pereira dos; Lucena, Leandro Ricardo Rodrigues de

doi:10.1590/0102-672020180001e1361

Cited by 5 publications

(13 citation statements)

References 25 publications

(23 reference statements)

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“…Ten studies investigated prophylactic CPAP (28–34, 37 40, 43), six studies utilized NIV (35, 36, 39, 41, 42, 44), and one study (38) compared both NIV and CPAP with standard care. Eleven studies implemented continuous therapy (28, 31, 33–38, 40, 42, 43), and six studies used intermittent (29, 30, 32, 39, 41, 44).…”

Section: Resultsmentioning

confidence: 99%

“…However, the postoperative data from this metaanalysis were heavily weighted by one study focusing on cardiac surgery (46). Since these earlier systematic reviews (16,17), an additional nine studies have been published (36)(37)(38)(39)(40)(41)(42)(43)(44). Despite an increase in the available evidence, the majority are of generally low quality and do not give definitive answers.…”

Section: Discussionmentioning

confidence: 99%

“…The 17 trials included in this review were published between 1981 and 2022 (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44). The pooled sample size was 6,108 participants, with the largest study contributing 78% to the overall sample (43).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…A meta-analysis of 16 trials (28)(29)(30)(31)(32)(33)(34)(35)(37)(38)(39)(40)(41)(42)(43)(44) demonstrated no significant evidence of benefit for prophylactic NIV/CPAP to reduce PPC compared with standard care (RR, 0.89; 95% CI, 0.78-1.01; very low certainty), as shown in Figure 2. The pooled estimated PPC occurrence rate was 9% in participants who received prophylactic NIV/CPAP compared with 10% in participants who did not receive prophylactic NIV/ CPAP.…”

Section: Prophylactic Niv and Cpap On Ppc Occurrencementioning

confidence: 99%

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Prophylactic Postoperative Noninvasive Ventilation in Adults Undergoing Upper Abdominal Surgery: A Systematic Review and Meta-Analysis

Lockstone

Denehy

Truong

et al. 2022

Critical Care Medicine

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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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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Prophylactic Niv and Cpap On Ppc Occurrencementioning

confidence: 99%

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Prophylactic Postoperative Noninvasive Ventilation in Adults Undergoing Upper Abdominal Surgery: A Systematic Review and Meta-Analysis

Lockstone

Denehy

Truong

et al. 2022

Critical Care Medicine

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“…However, the number needed to treat to prevent one PPC was 11.3 A randomized control trial assessed the efficacy of NIV in addition to standard therapy in 50 obese patients undergoing bariatric surgery. There were reduced events of both pneumonia and atelectasis with NIV usage [ 23 ]. These findings imply that utilization of preoperative NIV and a structured plan for delivering NIV postoperatively can prevent PPCs in the increasing population of obese surgical patients.…”

Section: Resultsmentioning

confidence: 99%

Pre-operative patient optimization to prevent postoperative pulmonary complications—Insights and roles for the respiratory therapist: A narrative review

et al. 2020

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Background: The preoperative period has gained recognition as a crucial time to identify and manage preoperative medical conditions for preventing perioperative complications. Consequently, preoperative clinics have now become an essential component of perioperative care at many large hospitals. As the prevalence of preoperative clinics continues to grow, and the field of perioperative medicine progresses, respiratory therapists (RTs) will inevitably find a growing role to participate in preoperative patient optimization to mitigate pulmonary complications. Methods: Keyword searches on perioperative pulmonary complications were conducted on the Medline database via PubMed and identified over 2000 candidate articles for review. Articles were included if they were English only and resulted with one or more of the following search terms; pulmonary complications, postoperative complications, postoperative pulmonary complications (PPCs), prehabilitation, incentive spirometry, smoking cessation, noninvasive ventilation. Preference was given for meta-analyses, randomized controlled trials, and systematic reviews. Publications within the past two decades were given additional preference toward final inclusion. The authors discussed eligible articles in group meetings over the span of multiple years to assess relevance and quality of data for narrowing eligible articles to the final selection of publications for the review. Findings: The following narrative review examines preoperative optimization strategies to prevent PPCs and highlight areas where RTs may play a key role. After examining challenges in defining PPCs, the review examines key risk models available to predict PPCs and their implications for subsequent discussion on preventive measures that RTs may assist with in a multidisciplinary team. Conclusion: RTs can reduce the health care burden of PPCs by assisting fellow perioperative clinicians in providing respiratory care for patients with premorbid conditions. While much of our review focused on pre-existing pulmonary pathologies and both the pharmacological and nonpharmacological optimization of these pathologies, there are other factors contributing to PPCs deserving future exploration.

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Noninvasive Ventilation in Postoperative Patients

Karim

Oks

Singh

2020

Noninvasive Ventilation in Sleep Medicine and Pulmonary Critical Care

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Non-Invasive Preventive Ventilation With Two Pressure Levels in the Postoperative Period of Roux-en-Y Gastric Bypass: Randomized Trial

Cited by 5 publications

References 25 publications

Prophylactic Postoperative Noninvasive Ventilation in Adults Undergoing Upper Abdominal Surgery: A Systematic Review and Meta-Analysis

Prophylactic Postoperative Noninvasive Ventilation in Adults Undergoing Upper Abdominal Surgery: A Systematic Review and Meta-Analysis

Pre-operative patient optimization to prevent postoperative pulmonary complications—Insights and roles for the respiratory therapist: A narrative review

Noninvasive Ventilation in Postoperative Patients

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