Intraoperative prophylactic and therapeutic non-invasive ventilation: a systematic review

Abstract

Non-invasive ventilation (NIV) has been used to prevent or to treat perioperative acute respiratory failure (ARF). Intraoperative prophylactic and therapeutic use of NIV could be of interest to patients with anticipated difficulty in postoperative weaning from mechanical ventilation or to patients refusing tracheal intubation. Intraoperative NIV might also be useful when deep sedation is required, as this can cause respiratory depression. PubMed, Embase, Google Scholar, and Cochrane Library were searched for pertinent studies. Inclusion criteria were NIV use during surgery and adult patients; the exclusion criteria were NIV application only in the preoperative or postoperative periods, paediatric patients, NIV applied as negative pressure ventilation. Thirty papers including 618 patients were included for final analysis. Intraoperative therapeutic NIV to treat ARF was reported for 92 patients and in all those cases, including six Caesarean sections, surgery was completed uneventfully. Intraoperative prophylactic NIV to avoid ARF was described in 24 patients with severe respiratory limitation and in 502 healthy patients during deep sedation. Three patients could not be successfully ventilated due to upper airway obstruction, but no further complication was reported. Intraoperative NIV appears feasible, safe, and potentially useful, particularly when tracheal intubation is best avoided. However, high-quality, randomized studies are required.

Noninvasive ventilation during spontaneous breathing anesthesia: an observational study using electrical impedance tomography

“…Use of NIV during anesthesia has already been described [10]. Three studies previously described the feasibility of NIV during anesthesia in a total of 498 patients [16][17][18].…”

“…PSV is a ventilator mode recently available in anesthesia ventilators. Use of NIV in anesthesia has been reported during the preoxygenation phase in obese patients to enhance oxygenation before intubation [8,9] and also in the intraoperative period in 3 settings [10]: therapeutic to treat an established perioperative acute respiratory failure, prophylactic in patients with chronic severe respiratory limitations, and prophylactic in sedated healthy patients to avoid hypoventilation due to anesthesia [11][12][13][14][15][16][17][18]. Effects of spontaneous breathing during general anesthesia were assessed by comparing the ventilation distribution in 30 nonobese patients enrolled in a randomized trial [19].…”

Preventive and therapeutic noninvasive ventilation in cardiovascular surgery

“…Noninvasive ventilation is growingly applied also in operative procedures and even in the operating room [35]. It could be a useful resource for the cardiovascular procedures performed percutaneously or in locoregional anesthesia, especially, when sedation is provided.…”

Comparison of the effects of continuous and intermittent non invasive mechanical ventilation on cardiorespiratory parameters and autonomic modulation of healthy individuals

“…Esta resposta pode estar associada às repercussões cardiovasculares promovidas pela VMNI, ou seja, o aumento da pressão intratorácica promove diminuição da pré e pós-carga facilitando a contratilidade miocárdica, o que produz diminuição da FC, características que são controladas pela atividade predominantemente vagal. 23,33,37 Somado a estes fatores previamente descritos, pode-se também associar em parte, o aumento da modulação parassimpática á diminuição da FR que ocorreu no momento de ventilação nas duas modalidades, porém com significância apenas na modalidade contínua. 2,29 Estudos encontrados na literatura apresentam resultados divergentes sobre o comportamento do balanço autonômico durante a VMNI 2,3,4,32 , o que pode estar relacionado aos diferentes protocolos aplicados (pressão, tempo de aplicação e população estudada.…”