Perioperative noninvasive ventilation in obese patients: a qualitative review and meta-analysis

Carron, Michele; Zarantonello, Francesco; Tellaroli, Paola; Ori, Carlo

doi:10.1016/j.soard.2015.12.013

Cited by 56 publications

(36 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…124 A recent meta-analysis showed a reduction in respiratory complications [RR (CI) 0.33 (0.16-0.66)] with pre-and postoperative non-invasive ventilation in obese patients, but only a trend towards a reduction in unplanned re-intubation and intensive care admission. 125 Further large, high-quality RCTs are required.…”

Section: Study Techniquementioning

confidence: 99%

Postoperative pulmonary complications

Miskovic

Lumb

2017

British Journal of Anaesthesia

736

596

View full text Add to dashboard Cite

Postoperative pulmonary complications (PPCs) are common, costly, and increase patient mortality. Changes to the respiratory system occur immediately on induction of general anaesthesia: respiratory drive and muscle function are altered, lung volumes reduced, and atelectasis develops in > 75% of patients receiving a neuromuscular blocking drug. The respiratory system may take 6 weeks to return to its preoperative state after general anaesthesia for major surgery. Risk factors for PPC development are numerous, and clinicians should be aware of non-modifiable and modifiable factors in order to recognize those at risk and optimize their care. Many validated risk prediction models are described. These have been useful for improving our understanding of PPC development, but there remains inadequate consensus for them to be useful clinically. Preventative measures include preoperative optimization of co-morbidities, smoking cessation, and correction of anaemia, in addition to intraoperative protective ventilation strategies and appropriate management of neuromuscular blocking drugs. Protective ventilation includes low tidal volumes, which must be calculated according to the patient's ideal body weight. Further evidence for the most beneficial level of PEEP is required, and on-going randomized trials will hopefully provide more information. When PEEP is used, it may be useful to precede this with a recruitment manoeuvre if atelectasis is suspected. For high-risk patients, surgical time should be minimized. After surgery, nasogastric tubes should be avoided and analgesia optimized. A postoperative mobilization, chest physiotherapy, and oral hygiene bundle reduces PPCs.

show abstract

Section: Study Techniquementioning

confidence: 99%

Postoperative pulmonary complications

Miskovic

Lumb

2017

British Journal of Anaesthesia

736

596

View full text Add to dashboard Cite

show abstract

“…Its role in obese patients has been highlighted in a recent metaanalysis [43]. Nonetheless, a recent review showed that preventive CPAP could reduce the intubation rate, but there are not enough data to support its use in all patients, and that further studies are warranted [44 && ].…”

Section: Noninvasive Ventilation In the Postoperative Periodmentioning

confidence: 99%

Postoperative respiratory disorders

Ball

Battaglini

Pelosi

2016

Current Opinion in Critical Care

View full text Add to dashboard Cite

show abstract

“…As the beneficial effects of protective intraoperative mechanical ventilation may be lost after extubation, CPAP or NIPPV may be considered after extubation. The safety and efficacy of CPAP or NIPPV have been established in the perioperative period, and they should be considered in high‐risk obese patients ( Fig . ).…”

Section: Resultsmentioning

confidence: 99%

Perioperative care of the obese patient

Carron

Fakhr

Ieppariello

et al. 2020

British Journal of Surgery

View full text Add to dashboard Cite

Background Obesity has become an increasing problem worldwide during the past few decades. Hence, surgeons and anaesthetists will care for an increasing number of obese patients in the foreseeable future, and should be prepared to provide optimal management for these individuals. This review provides an update of recent evidence regarding perioperative strategies for obese patients. Methods A search for papers on the perioperative care of obese patients (English language only) was performed in July 2019 using the PubMed, Scopus, Web of Science and Cochrane Library electronic databases. The review focused on the results of RCTs, although observational studies, meta‐analyses, reviews, guidelines and other reports discussing the perioperative care of obese patients were also considered. When data from obese patients were not available, relevant data from non‐obese populations were used. Results and conclusion Obese patients require comprehensive preoperative evaluation. Experienced medical teams, appropriate equipment and monitoring, careful anaesthetic management, and an adequate perioperative ventilation strategy may improve postoperative outcomes. Additional perioperative precautions are necessary in patients with severe morbid obesity, metabolic syndrome, untreated or severe obstructive sleep apnoea syndrome, or obesity hypoventilation syndrome; patients receiving home ventilatory support or postoperative opioid therapy; and obese patients undergoing open operations, long procedures or revisional surgery.

show abstract

Perioperative noninvasive ventilation in obese patients: a qualitative review and meta-analysis

Cited by 56 publications

References 50 publications

Postoperative pulmonary complications

Postoperative pulmonary complications

Postoperative respiratory disorders

Perioperative care of the obese patient

Contact Info

Product

Resources

About