Effect of adding postoperative noninvasive ventilation to usual care to prevent pulmonary complications in patients undergoing coronary artery bypass grafting: A randomized controlled trial

Jaaly, Emad Al; Fiorentino, Francesca; Reeves, Barnaby C; Ind, Philip W.; Angelini, Gianni; Kemp, Scott; Shiner, Robert J.

doi:10.1016/j.jtcvs.2013.03.014

Cited by 54 publications

(66 citation statements)

References 25 publications

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“…CT results because tests were not conducted on a routine basis. Accordingly, diagnostic differences between our study and previous studies that used CT and PFT may have resulted in a higher reported incidence of atelectasis (45.2% vs. 37.84% and 13.49%) [4,25].…”

Section: Discussioncontrasting

confidence: 73%

Continuous Positive Airway Pressure Therapy Can Prevent Pulmonary Atelectasis after Laparoscopic Roux-en-Y Gastric Bypass Surgery in Obese Patients

Ahn

Bae

Suh

et al. 2019

J Metab Bariatr Surg

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Purpose: To compare the prophylactic effects of postoperative continuous positive airway pressure (CPAP) therapy plus conventional postoperatively pulmonary physiotherapy (CPP) and postoperative CPP alone on the development of pulmonary atelectasis after laparoscopic Roux-en-Y gastric bypass (LGBP) in obese patients. Materials and Methods: Patients with BMIs＞27.5 kg/m 2 aged between 20 and 65 years were enrolled in the present study. All subjects received LGBP and were divided into 2 groups. Patients in the CPAP group received both CPAP and CPP therapy postoperatively, and patients in the conventional group received CPP alone. The primary outcome was the incidence of postoperative pulmonary atelectasis as determined by chest X-ray after LGBP, and the secondary outcome was duration of postoperative hospital stay (HS). Results: Seventy-three patients were enrolled in this study. Fifty-seven patients received CPAP plus CPP, and 16 patients received CPP. The CPAP group had an atelectasis incidence of 40.4% (23/57) and the conventional group an incidence of 62.5% (10/16). Multivariate analysis showed the incidence of atelectasis after LGBP was significantly lower in the CPAP group (OR 0.198, 95% CI 0.045-0.874; P=0.033) and that HS was significantly correlated with the developments of atelectasis, pneumonia, and complications (partial correlation coefficients 0.271, 0.444 and 0.382; P-values 0.025, ＜0.05 and ＜0.05, respectively). Conclusion: Patients that received continuous positive airway pressure therapy plus conventional pulmonary physiotherapy postoperatively were at significantly less risk of developing pulmonary atelectasis after LGBP than patients that received conventional pulmonary physiotherapy postoperatively.

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Section: Discussioncontrasting

confidence: 73%

Continuous Positive Airway Pressure Therapy Can Prevent Pulmonary Atelectasis after Laparoscopic Roux-en-Y Gastric Bypass Surgery in Obese Patients

Ahn

Bae

Suh

et al. 2019

J Metab Bariatr Surg

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“…Taking into account a two-sided significance level of 0.05 and power of 80%, we determined the required sample size to be 30 patients. Previous studies of non-invasive ventilation in postsurgical patients have reported a high rate of insufficient adherence to the CPAP treatment 23 . Thus, we aimed to include 45 patients in order to arrive at the desired sample size.…”

Section: Methodsmentioning

confidence: 94%

Continuous Positive Airway Pressure Mitigates Opioid-induced Worsening of Sleep-disordered Breathing Early after Bariatric Surgery

et al. 2016

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Background Bariatric surgery patients are vulnerable to sleep-disordered breathing (SDB) early after recovery from surgery and anesthesia. The authors hypothesized that continuous positive airway pressure (CPAP) improves postoperative oxygenation and SDB and mitigates opioid-induced respiratory depression. Methods In a randomized crossover trial, patients after bariatric surgery received 30% oxygen in the postanesthesia care unit (PACU) under two conditions: atmospheric pressure and CPAP (8 to 10 cm H2O). During 1 h of each treatment, breathing across cortical arousal states was analyzed using polysomnography and spirometry. Arousal state and respiratory events were scored in accordance with American Academy of Sleep Medicine guidelines. Data on opioid boluses in the PACU were collected. The primary and secondary outcomes were the apnea hypopnea index (AHI) and apnea after self-administration of opioids in the PACU. Linear mixed model analysis was used to compare physiologic measures of breathing. Results Sixty-four percent of the 33 patients with complete postoperative polysomnography data demonstrated SDB (AHI greater than 5/h) early after recovery from anesthesia. CPAP treatment decreased AHI (8 ± 2/h vs. 25 ± 5/h, P < 0.001), decreased oxygen desaturations (5 ± 10/h vs. 16 ± 20/h, P < 0.001), and increased the mean oxygen saturation by 3% (P = 0.003). CPAP significantly decreased the respiratory-depressant effects observed during wakefulness–sleep transitions without affecting hemodynamics. The interaction effects between CPAP treatment and opioid dose for the dependent variables AHI (P < 0.001), inspiratory flow (P = 0.002), and minute ventilation (P = 0.015) were significant. Conclusions This pharmacophysiologic interaction trial shows that supervised CPAP treatment early after surgery improves SDB and ameliorates the respiratory-depressant effects of opioids without undue hemodynamic effects.

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“…(27,28) In a prospective study of patients after cardiac surgery, Zhu et al concluded that the use of NIV is associated with a lower reintubation rate (18.8% versus 80.9%), lower incidence of VAP (0 versus 17%) and the lowest mortality rate (18.8% versus 38.3%) compared to conventional treatment. (29) In a meta-analysis study, Olper et al demonstrated effectiveness of the use of NIV in reducing reintubation in fourteen clinical trials that evaluated the benefits after cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Reintubation of patients submitted to cardiac surgery: a retrospective analysis

Shoji¹,

Figuereido²,

Calixtre³

et al. 2017

Revista Brasileira De Terapia Intensiva

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ObjectivesTo analyze patients after cardiac surgery that needed endotracheal reintubation and identify factors associated with death and its relation with the severity scores.MethodsRetrospective analysis of information of 1,640 patients in the postoperative period of cardiac surgery between 2007 and 2015.ResultsThe reintubation rate was 7.26%. Of those who were reintubated, 36 (30.3%) underwent coronary artery bypass surgery, 27 (22.7%) underwent valve replacement, 25 (21.0%) underwent correction of an aneurysm, and 8 (6.7%) underwent a heart transplant. Among those with comorbidities, 54 (51.9%) were hypertensive, 22 (21.2%) were diabetic, and 10 (9.6%) had lung diseases. Among those who had complications, 61 (52.6%) had pneumonia, 50 (42.4%) developed renal failure, and 49 (51.0%) had a moderate form of the transient disturbance of gas exchange. Noninvasive ventilation was performed in 53 (44.5%) patients. The death rate was 40.3%, and mortality was higher in the group that did not receive noninvasive ventilation before reintubation (53.5%). Within the reintubated patients who died, the SOFA and APACHE II values were 7.9 ± 3.0 and 16.9 ± 4.5, respectively. Most of the reintubated patients (47.5%) belonged to the high-risk group, EuroSCORE (> 6 points).ConclusionThe reintubation rate was high, and it was related to worse SOFA, APACHE II and EuroSCORE scores. Mortality was higher in the group that did not receive noninvasive ventilation before reintubation.

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Effect of adding postoperative noninvasive ventilation to usual care to prevent pulmonary complications in patients undergoing coronary artery bypass grafting: A randomized controlled trial

Cited by 54 publications

References 25 publications

Continuous Positive Airway Pressure Therapy Can Prevent Pulmonary Atelectasis after Laparoscopic Roux-en-Y Gastric Bypass Surgery in Obese Patients

Continuous Positive Airway Pressure Therapy Can Prevent Pulmonary Atelectasis after Laparoscopic Roux-en-Y Gastric Bypass Surgery in Obese Patients

Continuous Positive Airway Pressure Mitigates Opioid-induced Worsening of Sleep-disordered Breathing Early after Bariatric Surgery

Reintubation of patients submitted to cardiac surgery: a retrospective analysis

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