Prophylactic respiratory management after liver resection with bilevel positive airway pressure ventilation: Report of three cases

Abstract

Pulmonary complications after hepatectomy occur with relative frequency and are associated with increased morbidity and mortality. Moreover, their prevention is often difficult. We report using prophylactic bilevel positive airway pressure ventilation, initiated just after the operation, for the successful postoperative respiratory management of three patients predisposed to the development of pulmonary complications. One patient had insufficient pulmonary function (forced expiratory volume in 1 s (FEV(1)) 0.95 l; FEV(1)/forced vital capacity 40.8%) caused by previous thoracoplasty. The other two patients were obese and had obstructive sleep apnea syndrome (OSAS). None of the patients required endotracheal intubation after hepatectomy, although the two with severe OSAS suffered pulmonary thromboembolism postoperatively. Bilevel positive airway pressure ventilation was well tolerated and there were no adverse effects, suggesting its effectiveness for preventing pulmonary complications after hepatectomy.

Predictive Factors for Reintubation following Noninvasive Ventilation in Patients with Respiratory Complications after Living Donor Liver Transplantation

“…Although this report was comprehensive regarding the usefulness of NIV during the perioperative LDLT stage, risk factors for reintubation following NIV treatment were not discussed, which is the topic of the current report. Previously, although we addressed the general effectiveness of NIV in both adult and infant patients [18]–[21], [24], [25], this report provides more specific information on the topic than those reports or the recent review. This retrospective study was done in an institution with extensive experience in the use of NIV [2], and the relatively high rate of use of NIV treatment could be explained by the high mean MELD scores (24.2) in the 179 patients whose data were analyzed.…”

“…Ventilation in all patients was by bilevel positive airway pressure (bilevel PAP) devices with oxygen and humidification (VPAP series Resmed) [18]–[21], [24], [25]. After the mask had been secured, the level of support pressure and expiratory positive airway pressure (EPAP) and the amount of oxygen were progressively increased until SaO 2 was >95%, accompanied by decreased respiratory rates and/or reduced activity of accessory muscles for respiration, decreased paradoxical thoraco-abdominal movement, and improvement in respiratory discomfort.…”

Acute Respiratory Failure Complicating Advanced Liver Disease

“…More recently, there have been several case reports by Narita and associates and Nagai and colleagues describing the successful use of NIV for posttransplant or posthepatectomy patients. 119,120 Although NIV may appear to be an attractive option for respiratorycompromised liver failure patients, its use is not standard practice for patients with cirrhosis who need respiratory support. Caution should thus be taken when using NIV in liver failure especially in light of the often concurrent alterations in mental status in this patient population.…”

Critical care of the end-stage liver disease patient awaiting liver transplantation

“…Most of the randomized studies have been performed in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and hypercapnic respiratory failure 90. There have been several case reports describing the successful use of noninvasive ventilation for posttransplant or posthepatectomy patients 91, 92. Whether other causes of respiratory failure are as amenable to noninvasive weaning remains to be determined.…”