Does non-invasive ventilation associated with chest physiotherapy improve outcome after lung resection?

Abstract

A best evidence topic was constructed according to a structured protocol. The question addressed was whether the use of non-invasive ventilation (NIV) associated with chest physiotherapy (CPT) is effective in preventing respiratory complications in patients undergoing lung resection surgery. Of the 172 papers found using a report search, five presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that, on the whole, the five studies were all in favor of NIV as an adjuvant to CPT for improving outcome after lung resection surgery. Indeed, the interest and benefit has been shown not only in the treatment of postoperative acute respiratory failure, but also in the prevention and treatment of respiratory complications (atelectasis, pneumonia and bronchial congestion). Hence, current evidence shows NIV associated with acute CPT management to be safe and effective in reducing postoperative complications and in improving patient recovery, thus enhancing the choice of available medical care and bettering outcome in lung resection surgery.

Respiratory muscle strength no influence the need for noninvasive ventilation after heart surgery

“…with no signs or symptoms of respiratory insufficiency, has been used in order to prevent respiratory complications. A literature review 25 has highlighted that NIV, associated with respiratory physical therapy, is a safe and effective resource to reduce and treat PO complications. In this study, 22% of NIV occured in patients who had been radiologicaly involved, however, without clinical manifestations, and 6% immediately after extubation, due to preoperative risk factors.…”

“…A randomized study 26 used NIV in a prophylactic way in 500 patients, and demonstrated that NIV improves oxygenation, reduces respiratory complications and hospital readmissions. The preventive use of NIV within 48 hours after cardiac surgery, improves the values of ventilometry, respiratory muscle strength and peak of expiratory flow, which can prevent respiratory complications 5,25,26 . The subjects studied were characterized overweight (average BMI 28 kg/m²).…”

Postoperative Pulmonary Rehabilitation in Thoracic Surgery

“…Uygulamaları; postoperatif toraks cerrahisinde noninvaziv mekanik ventilasyon (NİMV) kullanımı ile ilgili az sayıda araştırma olmasına rağmen, akciğer rezeksiyonu yapılan hastalarda NİMV'nin sadece akut solunum yetmezliği olan hastalarda değil, tüm hastalar için pnömoni, atelektazi ve bronşiyal konjesyon gibi postoperatif komplikasyonları azaltarak, iyileşmeyi hız-landıran, emniyetli ve etkili uygulamalar olduğu kabul edilmektedir (36).…”

Postoperative Care of Patients Undergoing Lung Resection

“…In patients who received low Vt (5 mL/kg) with a PEEP level of 5 cmH2O, as compared to a Vt of 10 mL/ kg and no PEEP, Michelet and coworkers [42] reported an attenuated systemic proinflamatory response, reduced extravascular lung water index, and improved PaO2 /FiO2 that allowed earlier extubation. Even though early postoperative use of continuous positive airway pressure (CPAP) or NIV with pressure support may result in faster improvement of arterial hypoxemia, their advantage in reducing the risk of PPC has been reported only in a few trials, and particularly when non invasive ventilatory support was associated with chest physiotherapy [43]. Besides Perrin's study [10] where NIV showed an improvement of oxygenation and a reduction in atelectasis, the benefits from non invasive ventilatory support are mainly reported in the treatment of rather than in prevention of postoperative acute respiratory failure [44,45].…”