Non-Invasive Pressure Support Ventilation in Major Lung Resection for High Risk Patients: Does It Matter?

Abstract

Background and purpose: Patients with severely impaired pulmonary function have an increased operative risk for major lung resection. The clinical benefits of pre-and perioperative, non-invasive pressure support ventilation (NIPSV) have up to now not been extensively evaluated. Patients with severely reduced pulmonary function were investigated in this prospective and randomised single centre clinical trial. Methods: Standard pulmonary evaluation was performed in all patients before major lung resection. To predict postoperative pulmonary function, a lung perfusion-ventilation scan was carried out. All patients enrolled in the study were instructed preoperatively on how to use a NIPSV respirator. After lung resection patients were randomised either for continuation of NIPSV or for standard treatment. Results: Of the 52 patients assessed, 21 patients met the inclusion criteria for the study protocol. Predicted mean postoperative FEV 1 was 1.10 L (range 0.92 -1.27 L). Lobectomy was performed in 14 patients, pneumonectomy in 6 patients and a segmentectomy in 1 patient. No inhospital deaths occurred. Pulmonary complications (reintubation, pneumonia) were more frequent in the NIPSV group than in the control group (3 patients versus 1 patient), without statistical significance (p = 0.31). Conclusions: We observed no mortality and a low morbidity in this high risk group. Postoperative continuation of NIPSV had no beneficial effect on the clinical outcome. Preoperative conditioning with NIPSV, however, seems to be a suitable tool for patients with severely impaired pulmonary function. This study may serve therefore as basis for further investigations for the potential clinical benefits of prophylactic NIPSV in major lung surgery.

The effects of various respiratory physiotherapies after lung resection: a systematic review

“…The literature search in databases provided 11 studies (Agostini et al, 2013;Aguiló et al, 1997;Arbane et al, 2014;Barbagallo et al, 2012;Frolund and Madsen, 1986;Garutti et al, 2014;Lorut et al, 2014;Ludwig et al, 2011;Nery et al, 2012;Reeve et al, 2010;Roceto, Galhardo, Saad, and Toro, 2014). Additionally, two studies (Arbane, Tropman, Jackson, and Garrod, 2011;Danner et al, 2012) were identified from the reference list of a relevant article.…”

“…The included studies recruited a total of 1280 patients scheduled for lung surgery with a mean age between 51.9 (SD 5.5) (Aguiló et al, 1997) and 71.1 (SD 7.7) (Danner et al, 2012); approximately, 65% in the intervention group and 66% in the control group were male. Two studies included patients undergoing VATS (Arbane et al, 2014;Arbane, Tropman, Jackson, and Garrod, 2011).…”

Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care

“…Although NIV offers the potential to improve lung function, unload respiratory muscles and reduce postoperative hypoxemia and atelectasis, randomized controlled trials have not shown consistent evidence that the addition of either NIV or continuous positive airway pressure (CPAP) to standard medical therapy offers no significant benefit (Lorut et al 2014 ; Nery et al 2012 ; Aguilo et al 1997 ; Barbagallo et al 2012 ; Danner et al 2012 ; Garutti et al 2014 ; Liao et al 2010 ; Perrin et al 2007 ). In a recent Cochrane review of eight trials involving a total of 486 patients, there were no significant differences between patients receiving NIV and control groups in terms of pulmonary complications (RR 1.03, 95% CI 0.72–1.47), intubation rates (RR 0.55, 95% CI 0.25–1.00), mortality (RR 0.60, 95% CI 0.24–1.53), length of ICU stay (mean difference − 0.75 days, 95% CI − 3.93–2.43) or length of hospital stay (mean difference − 0.12 days, 95% CI − 6.15–5.90) (Torres et al 2019 ).…”

“…Risk stratification of candidates for thoracic surgery is likely to be useful for selecting sub-sets of patients who may benefit from either prophylactic or therapeutic NIV. These might include patients with COPD or severely impaired respiratory function (Danner et al 2012 ; Garutti et al 2014 ; Perrin et al 2007 ) and obese patients (Stephan and Berard 2017 ). Further research is needed to clarify the potential usefulness of prophylactic or therapeutic NIV in such groups, and to determine the most efficacious scheduled regimens.…”

Use of lung expansion techniques on drained and non-drained pleural effusion: survey with 232 physiotherapists

“…In the absence of guidelines resulting from clinical trials with good methodological quality, chest physiotherapists base their therapeutic choices on their beliefs or knowledge acquired at clinical practice. To get to know the reality of clinical practice, a survey is the indicated investigation method [14]. Therefore, the objective of this study was to know the lung expansion techniques applied by the chest physiotherapists who treat patients with drained and non-drained pleural effusion.…”