Noninvasive Ventilation Reduces Mortality in Acute Respiratory Failure following Lung Resection

Abstract

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 randomized prospective trial to compare standard 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%) randomly 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.

Step-by-step clinical management of one-lung ventilation: Continuing Professional Development

“…52 Noninvasive ventilation has additionally been shown to decrease mortality and the need for re-intubation in the setting of acute respiratory failure after lung resection. 53 Recommendations…”

“…52 En outre, il a été démontré que la ventilation non invasive réduisait la mortalité et le besoin de réintubation dans le contexte d'une insuffisance respiratoire aiguë après résection pulmonaire. 53 Recommandations…”

Preventive or curative postoperative noninvasive ventilation after thoracic surgery: still a grey zone?

“…It has been suggested [1] that there are two potential goals of NIV in the post-operative period ( Fig. 1): (1) to prevent ARF (prophylactic treatment), or (2) to treat ARF and avoid reintubation (curative treatment).…”

“…To date, only one RCT [2] has been performed in hypoxemic ARF after thoracic surgery using NIV as curative strategy. Auriant et al [2] randomized 48 patients with ARF after lung resection surgery to NIV (n = 24) or standard therapy (n = 24).…”

“…Auriant et al [2] randomized 48 patients with ARF after lung resection surgery to NIV (n = 24) or standard therapy (n = 24). Despite the small sample size, there was a significant decrease in the need for reintubation in the NIV group versus standard group (who did not receive NIV) (50 vs. 21 %, p \ 0.05) and also a significant reduction in mortality (37.5 vs. 12.5 %, p \ 0.05).…”