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Erschienen in:
01.02.2014 | Editorial
Preventive or curative postoperative noninvasive ventilation after thoracic surgery: still a grey zone?
Erschienen in: Intensive Care Medicine | Ausgabe 2/2014
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Thoracic surgery procedures and anesthesia result in reduced lung volumes, respiratory muscle dysfunction and atelectasis. Thoracic surgery procedures are at high risk of developing postoperative pulmonary complications related to the characteristics of the patients, who are often COPD, and surgical aggression. The main respiratory modifications after thoracic surgery mostly lead to atelectasis, hypoxemia, acute respiratory failure (ARF), pneumonia, or bronchopulmonary fistula, with a high mortality rate. Postoperative noninvasive ventilation (NIV) may be a helpful additional symptomatic treatment in these patients after surgery (Table 1). It has been suggested [1] that there are two potential goals of NIV in the post-operative period (Fig. 1): (1) to prevent ARF (prophylactic treatment), or (2) to treat ARF and avoid reintubation (curative treatment).
Table 1
Main studies using postoperative noninvasive ventilation after thoracic surgery
|
Authors
|
Year
|
Type of surgery
|
Study design
|
Patients
|
NIV mode
|
Interface
|
Main results
|
|---|---|---|---|---|---|---|---|
|
Preventive
|
|||||||
|
Aguilo [7]
|
1997
|
Pulmonary
|
Physiological
|
n = 20
2 groups
|
SB
PSV+10-PEEP+5
|
Nasal
|
Oxygenation improvement
|
|
Kindgen-Miles [8]
|
2005
|
Thoraco-abdominal
|
Prospective, randomized
|
n = 50
2 groups
|
SB
CPAP+10
|
Nasal
|
Oxygenation improvement, hospital stay decrease
|
|
Perrin [3]
|
2007
|
Pulmonary
|
Prospective, Randomized (before and after surgery)
|
n = 34
2 groups
|
SB
PSV+10-PEEP+5
|
Nasal
|
Oxygenation improvement, hospital stay decrease
|
|
Lorut [6]
|
2013
|
Pulmonary (COPD)
|
Prospective, randomized
|
n = 360
2 groups
|
SB
PSV+10-PEEP+5
|
Facial
|
No significant difference in acute respiratory events
|
|
Curative
|
|||||||
|
Kindgen-Miles [9]
|
2000
|
Thoraco-abdominal
|
Prospective, observational
|
n = 20
|
CPAP+10
|
Nasal
|
Oxygenation improvement,
|
|
Antonelli [10]
|
2000
|
Thoracic and abdominal (liver transplant, renal, lung)
|
Prospective, randomized
|
n = 40
2 groups
|
SB
PSV+15-PEEP+6
|
Facial
|
Intubation and mortality decrease
|
|
Rocco [11]
|
2001
|
Pulmonary (transplant)
|
Retrospective, observational
|
n = 21
|
PSV+14-PEEP+5
|
Facial
|
Feasability, safety. Oxygenation improvement
|
|
Auriant [2]
|
2001
|
Pulmonary
|
Prospective, randomized
|
n = 48
2 groups
|
SB
PSV+9-PEEP+4
|
Nasal
|
Intubation and mortality decrease
|
|
Lefebvre [4]
|
2009
|
Pulmonary
|
Prospective, observational
|
n = 113
|
PSV+14-PEEP+5
|
Facial
|
Feasability, safety, overall success rate of NIV 85 %
|
|
Riviere [5]
|
2010
|
Pulmonary
|
Retrospective, observational
|
n = 130
|
PSV+14-PEEP+5
|
Facial
|
Feasability, safety, overall success rate of NIV 70 %
|
Fig. 1
The two main strategy approaches for applying postoperative noninvasive ventilation (NIV, i.e., two positive pressure levels). Usually, there are two potential goals of NIV in the post-operative period: (1) to prevent acute respiratory failure (prophylactic treatment), or (2) to treat acute respiratory failure and avoid reintubation (curative treatment). It is sometimes difficult to clearly separate “preventive” to “curative” application of NIV. Probably, part of the patients received NIV for a “grey zone” indication (at the time of start of NIV and also after) which may be considered as an intermediary state between both “preventive” and “curative” application of NIV. CPAP continuous positive airway pressure (one positive pressure level), PSV pressure support ventilation, PEEP positive end expiratory pressure
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