Prevention of Postoperative Pulmonary Complications with CPAP, Incentive Spirometry, and Conservative Therapy

Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting

“…Trials of the use of noninvasive ventilation in patients who underwent lowrisk surgical procedures were generally small and reported only physiologic outcomes or found no difference in endotracheal intubation, hospital mortality or length of stay. 89,91,95,[97][98][99][102][103][104][105][106][107]109,111 The only exception was a recent large trial of continuous positive airway pressure by mask in 468 patients after cardiac surgery. 101 There was a reduction in a composite end point of pulmonary complications (arterial pressure of oxygen/fraction of inspired oxygen < 100, pneumonia or reintubation) and readmission to the ICU or an intermediate care unit.…”

Pre-operative pulmonary assessment for patients with hip fracture

“…A review found that these techniques consistently reduced the relative risk of pulmonary complications by approximately 50% [77]. If patients at high-risk of PPCs are not able to perform these techniques, postoperative CPAP is a good alternative [78, 79]. …”

The Scientific Basis for Postoperative Respiratory Care

“…43 Stock et al compared CPAP, incentive spirometry, and conservative therapy following upper abdominal surgery, and found that CPAP improved gas exchange and lung volumes, compared to incentive spirometry. 38 Other studies in this category showed no advantage of incentive spirometry over other techniques with respect to restoration of lung volumes. [31][32][33]35,37,40 Studies comparing incentive spirometry for PPC prevention after cardiac/thoracic surgery also include a trial with no intervention as the control, 48 and studies that compared incentive spirometry to other techniques.…”

“…1,29 In the ensuing 40 years a litany of studies evaluating incentive spirometry for preventing PPC have been published. Two main areas of investigation have been pursued: incentive spirometry for PPC prevention following upper abdominal surgery, [30][31][32][33][34][35][36][37][38][39][40][41][42][43] and incentive spirometry for PPC prevention following cardiac/thoracic surgery. [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] Comparison of these studies is difficult, owing to the various study designs (randomized controlled trials and prospective trials), the comparators (none, chest physical therapy [CPT], CPAP, expiratory airway pressure), the frequency of interventions (eg, hourly, every 4 hours), the duration of each intervention (number of maneuvers, minutes of therapy), and the outcomes (radiographic atelectasis, gas exchange, pneumonia, pulmonary function).…”

“…36,38 Nine studies have evaluated the use of CPAP to prevent PPCs in patients following upper abdominal surgery. 36,38,[68][69][70][71][72][73][74] As with incentive spirometry, the methodological differences in study design, outcomes, and comparators make comparisons difficult. All 9 were randomized trials, but the differences in equipment precluded blinding.…”