Non-Invasive Positive airway Pressure thErapy to Reduce Postoperative Lung complications following Upper abdominal Surgery (NIPPER PLUS): a pilot randomised control trial

Lockstone, Jane; Parry, Selina M.; Denehy, Linda; Robertson, Iain; Story, David A; Boden, Ianthe

doi:10.1016/j.physio.2022.06.001

Cited by 5 publications

(9 citation statements)

References 36 publications

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“…Ten studies investigated prophylactic CPAP (28–34, 37 40, 43), six studies utilized NIV (35, 36, 39, 41, 42, 44), and one study (38) compared both NIV and CPAP with standard care. Eleven studies implemented continuous therapy (28, 31, 33–38, 40, 42, 43), and six studies used intermittent (29, 30, 32, 39, 41, 44).…”

Section: Resultsmentioning

confidence: 99%

“…However, the postoperative data from this metaanalysis were heavily weighted by one study focusing on cardiac surgery (46). Since these earlier systematic reviews (16,17), an additional nine studies have been published (36)(37)(38)(39)(40)(41)(42)(43)(44). Despite an increase in the available evidence, the majority are of generally low quality and do not give definitive answers.…”

Section: Discussionmentioning

confidence: 99%

“…The 17 trials included in this review were published between 1981 and 2022 (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44). The pooled sample size was 6,108 participants, with the largest study contributing 78% to the overall sample (43).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The pooled sample size was 6,108 participants, with the largest study contributing 78% to the overall sample (43). Three studies reported participants preoperative PPC risk; one study (44) recruited only high-risk participants as defined by the Melbourne Risk Prediction Tool (7). Ferrando et al (40) enrolled intermediate-to high-risk participants as defined by the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score (45), and the Prevention of Respiratory Insufficiency after Surgical Management (PRISM) trial group (43) included high-risk participants also defined by the ARISCAT score (45).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…A meta-analysis of 16 trials (28)(29)(30)(31)(32)(33)(34)(35)(37)(38)(39)(40)(41)(42)(43)(44) demonstrated no significant evidence of benefit for prophylactic NIV/CPAP to reduce PPC compared with standard care (RR, 0.89; 95% CI, 0.78-1.01; very low certainty), as shown in Figure 2. The pooled estimated PPC occurrence rate was 9% in participants who received prophylactic NIV/CPAP compared with 10% in participants who did not receive prophylactic NIV/ CPAP.…”

Section: Prophylactic Niv and Cpap On Ppc Occurrencementioning

confidence: 99%

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Prophylactic Postoperative Noninvasive Ventilation in Adults Undergoing Upper Abdominal Surgery: A Systematic Review and Meta-Analysis

Lockstone

Denehy

Truong

et al. 2022

Critical Care Medicine

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OBJECTIVES: Postoperative pulmonary complications (PPCs) are a leading cause of morbidity and mortality following upper abdominal surgery. Applying either noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP) in the early postoperative period is suggested to prevent PPC. We aimed to assess whether postoperative NIV or CPAP or both prevent PPCs compared with standard care in adults undergoing upper abdominal surgery, including in those identified at higher PPC risk. Additionally, the different interventions used were evaluated to assess whether there is a superior approach. DATA SOURCES: We searched PubMed, Embase‚ CINAHL, CENTRAL, and Scopus from inception to May 17, 2021. STUDY SELECTION: We performed a systematic search of the literature for randomized controlled trials evaluating prophylactic NIV and/or CPAP in the postoperative period. DATA EXTRACTION: Two authors independently performed study selection and data extraction. Individual study risk of bias was assessed using the PEDro scale, and certainty in outcomes was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. DATA SYNTHESIS: We included 17 studies enrolling 6,108 patients. No significant benefit was demonstrated for postoperative NIV/CPAP to reduce PPC (risk ratio [RR], 0.89; 95% CI, 0.78–1.01; very low certainty), including in adults identified at higher PPC risk (RR, 0.91; 95% CI, 0.77–1.07; very low certainty). No intervention approach was identified as superior, and no significant benefit was demonstrated when comparing: 1) CPAP (RR, 0.90; 95% CI, 0.79–1.04; very low certainty), 2) NIV (RR, 0.68; 95% CI, 0.41–1.13; very low certainty), 3) continuous NIV/CPAP (RR, 0.90; 95% CI, 0.77–1.05; very low certainty), or 4) intermittent NIV/CPAP (RR, 0.66; 95% CI, 0.39–1.10; very low certainty) to standard care. CONCLUSIONS: These findings suggest routine provision of either prophylactic NIV or CPAP following upper abdominal surgery may not be effective to reduce PPCs‚ including in those identified at higher risk.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Prophylactic Niv and Cpap On Ppc Occurrencementioning

confidence: 99%

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Prophylactic Postoperative Noninvasive Ventilation in Adults Undergoing Upper Abdominal Surgery: A Systematic Review and Meta-Analysis

Lockstone

Denehy

Truong

et al. 2022

Critical Care Medicine

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PHYSIO+++: protocol for a pilot randomised controlled trial assessing the feasibility of physiotherapist-led non-invasive ventilation for patients with hypoxaemia following abdominal surgery

Hackett,

Denehy,

Kruger

et al. 2023

BMJ Open

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IntroductionFew clinical trials have investigated physiotherapy interventions to treat hypoxaemia following abdominal surgery. The objective of this study is to determine the feasibility and safety of conducting a clinical trial of physiotherapist-led non-invasive ventilation (NIV).Methods and analysisThis single-centre, 50-patient, parallel-group, assessor blinded, pilot feasibility randomised controlled trial with concealed allocation will enrol spontaneously ventilating adults with hypoxaemia within 72 hours of major abdominal surgery. Participants will receive either (1) usual care physiotherapy of a single education session (talk), daily walking of 10–15 min (walk) and four sessions of coached deep breathing and coughing (breathe) or (2) usual care physiotherapy plus four 30 min sessions of physiotherapist-led NIV delivered over 2 postoperative days. Primary feasibility and safety outcome measures are; number of eligible patients recruited per week, total time of NIV treatment delivered, acceptability of treatments to patients and clinicians and incidence of adverse events. Secondary feasibility outcomes include measures of recruitment and treatment adherence. Exploratory outcome measures include change in respiratory parameters, postoperative pulmonary complications, length of hospital stay, health-related quality of life, postoperative activity levels and mortality.Ethics and disseminationEthics approval has been obtained from the relevant institution. Results will be published to inform future research.Trial registration numberACTRN12622000839707.

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Effects of non-invasive respiratory support in post-operative patients: a systematic review and network meta-analysis

Pettenuzzo,

Boscolo,

Pistollato

et al. 2024

Crit Care

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Background Re-intubation secondary to post-extubation respiratory failure in post-operative patients is associated with increased patient morbidity and mortality. Non-invasive respiratory support (NRS) alternative to conventional oxygen therapy (COT), i.e., high-flow nasal oxygen, continuous positive airway pressure, and non-invasive ventilation (NIV), has been proposed to prevent or treat post-extubation respiratory failure. Aim of the present study is assessing the effects of NRS application, compared to COT, on the re-intubation rate (primary outcome), and time to re-intubation, incidence of nosocomial pneumonia, patient discomfort, intensive care unit (ICU) and hospital length of stay, and mortality (secondary outcomes) in adult patients extubated after surgery. Methods A systematic review and network meta-analysis of randomized and non-randomized controlled trials. A search from Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science from inception until February 2, 2024 was performed. Results Thirty-three studies (11,292 patients) were included. Among all NRS modalities, only NIV reduced the re-intubation rate, compared to COT (odds ratio 0.49, 95% confidence interval 0.28; 0.87, p = 0.015, I2 = 60.5%, low certainty of evidence). In particular, this effect was observed in patients receiving NIV for treatment, while not for prevention, of post-extubation respiratory failure, and in patients at high, while not low, risk of post-extubation respiratory failure. NIV reduced the rate of nosocomial pneumonia, ICU length of stay, and ICU, hospital, and long-term mortality, while not worsening patient discomfort. Conclusions In post-operative patients receiving NRS after extubation, NIV reduced the rate of re-intubation, compared to COT, when used for treatment of post-extubation respiratory failure and in patients at high risk of post-extubation respiratory failure.

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Non-Invasive Positive airway Pressure thErapy to Reduce Postoperative Lung complications following Upper abdominal Surgery (NIPPER PLUS): a pilot randomised control trial

Cited by 5 publications

References 36 publications

Prophylactic Postoperative Noninvasive Ventilation in Adults Undergoing Upper Abdominal Surgery: A Systematic Review and Meta-Analysis

Prophylactic Postoperative Noninvasive Ventilation in Adults Undergoing Upper Abdominal Surgery: A Systematic Review and Meta-Analysis

PHYSIO+++: protocol for a pilot randomised controlled trial assessing the feasibility of physiotherapist-led non-invasive ventilation for patients with hypoxaemia following abdominal surgery

Effects of non-invasive respiratory support in post-operative patients: a systematic review and network meta-analysis

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