Noninvasive positive pressure ventilation in the immediate post–bariatric surgery care of patients with obstructive sleep apnea: a systematic review

Tong, Solomon; Gower, Jonathan R.; Morgan, Austin; Gadbois, Kyle D.; Wisbach, Gordon

doi:10.1016/j.soard.2017.02.009

Cited by 23 publications

(9 citation statements)

References 33 publications

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“…52 In a review which included 11 studies of 5,801 patients undergoing bariatric surgery, 1,293 (22%) of patients received PPV and only 11 cases of anastomose leak were reported, yielding a rate of 0.8%, which was the same as in patients who did not receive PPV. 53 Other studies have shown no relation between anastomose leakage and NIV after bariatric surgery in obstructive sleep apnoea syndrome patients. 54,55 Nevertheless, sphincters may not function properly in some patients and can be as low as 11 cm H 2 O.…”

Section: Complications Of Noninvasive Ventilationmentioning

confidence: 96%

Noninvasive Ventilation: Challenges and Pitfalls

2018

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Noninvasive ventilation (NIV) is frequently used in patients with acute respiratory failure and its success is dependent on the underlying cause of the condition. When used for cases with a more rapid, reversible nature, like cardiogenic pulmonary oedema or acute exacerbations of chronic obstructive pulmonary disease, early intervention before patient deterioration is a key factor in success. Gastric distention-associated anastomose leakage after bariatric surgery is overestimated and the success of NIV trials in patients with encephalopathy has a strong association with the triggering cause rather than the severity of a coma. Immunocompromised patients mostly benefit from a short period of ventilation and more invasive ventilation is associated with excessively high mortality independent of the cause. In other diseases with parenchyma inflammation or infection, little success with NIV has been shown. Limiting ventilator-induced lung injury in these patients is another issue and is mostly achieved with heavy sedation or paralysis. Since NIV failure increases the risk of mortality, determination of a failing patient is of paramount importance. Clinical and laboratory surrogates of muscle fatigue can also be assessed. Adequate pressure support and positive end-expiratory pressure levels vary and the haemodynamic status of the patients must be considered. Ventilator–patient asynchrony increases NIV failure. Unfit interfaces also result in asynchrony, which will inevitably lead to failure, and observing waveforms can address this issue. The aims of this review were to understand the mechanism of NIV that leads to its failure or success, to become aware that delaying the appropriate therapy increases mortality, and to elucidate that spontaneous breathing can be a double-edged sword in some circumstances.

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Section: Complications Of Noninvasive Ventilationmentioning

confidence: 96%

Noninvasive Ventilation: Challenges and Pitfalls

2018

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“…However, in a systematic review of patients undergoing bariatric surgery, this concern was dispelled and instead NIPPV use reduced the risk of pulmonary complications. 92 Reijers et al 93 confirmed that postoperative CPAP use was not an independent predictor of anastomotic leakage in primary bariatric surgery and OSA was not associated with staple-line dehiscence and leakage. However, the authors did find an association between postoperative CPAP use and anastomotic leakage exclusively in revision procedures.…”

Section: Postoperative Noninvasive Positive Pressure Ventilation (Nip...mentioning

confidence: 97%

Bariatric surgery in patients with obstructive sleep apnea

Chen

Moon

Schumann

2022

International Anesthesiology Clinics

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According to the most recent International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Worldwide Survey, there were 685,874 bariatric operations performed in 2016. 1 As the prevalence of obesity increases, the number of patients who undergo bariatric surgery will also continue to rise. Surgeons, anesthesiologists, and other perioperative providers need to be aware of important comorbidities associated with obesity, particularly obstructive sleep apnea (OSA), in order to decrease morbidity and mortality in patients undergoing bariatric surgery.Based on recent studies, the prevalence of OSA worldwide is nearing one billion persons. 2 The prevalence of OSA in the bariatric surgery population has been reported to be anywhere between 35% and 94%. 3 One study that performed polysomnography (PSG) on all patients before bariatric surgery found an OSA rate of 47%. 4 Thus, the actual prevalence of OSA may be higher than some estimates due to patients with undiagnosed OSA.Sleep-disordered breathing (SDB), which leads to a higher rate of pulmonary and cardiovascular complications in the postoperative period, is common in patients with obesity. 5 Examining the significance of OSA as a comorbidity in patients undergoing bariatric surgical procedures is of special interest due to the strong association between OSA and obesity. The majority of weight loss surgeries are performed using a minimally invasive laparoscopic approach, which has a lower complication rate compared with open procedures. 6 To minimize morbidity and mortality and optimize resource utilization, it is appropriate to determine the ideal preoperative screening tests, intraoperative management, and postoperative monitoring techniques for patients with OSA undergoing bariatric surgery.

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“…Non-invasive pressure ventilation (NPPV) in the immediate postoperative period reduces the risk of respiratory complications and episodes of desaturation. [ 3 5 62 63 ] In patients with obesity and OSA, continuous positive airway pressure (CPAP) use in the postoperative period has been shown to reduce the risk of pulmonary complications, atelectasis, and reintubation. [ 3 34 64 ] Using bilevel positive airway pressure (BiPAP) immediately after extubation may be beneficial for maintenance of lung volumes and lung capacity.…”

Section: Literature Reviewmentioning

confidence: 99%

Airway management in patients with obesity

et al. 2022

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Airway management in patients with obesity remains a complex and evolving topic that is becoming more pertinent given the increasing prevalence of obesity and bariatric surgery worldwide. Obesity is associated with increased morbidity and mortality secondary to anesthetic complications, especially related to airway management. Preoperative assessment is especially vital for the bariatric patient so that potential predictors for a difficult airway can be identified. There are several airway management strategies and techniques for the bariatric population that may help reduce postoperative pulmonary complications. This review aims to discuss assessment of the airway, ideal patient positioning, intubation techniques and devices, apneic oxygenation, optimal ventilation strategies, and extubation and post-anesthesia care.

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Noninvasive positive pressure ventilation in the immediate post–bariatric surgery care of patients with obstructive sleep apnea: a systematic review

Cited by 23 publications

References 33 publications

Noninvasive Ventilation: Challenges and Pitfalls

Noninvasive Ventilation: Challenges and Pitfalls

Bariatric surgery in patients with obstructive sleep apnea

Airway management in patients with obesity

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