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01-02-2014 | Original Article

Early postoperative prophylactic noninvasive ventilation after major lung resection in COPD patients: a randomized controlled trial

Authors: Christine Lorut, Aurélie Lefebvre, Benjamin Planquette, Laurent Quinquis, Hervé Clavier, Nicola Santelmo, Halim Abou Hanna, François Bellenot, Jean-François Regnard, Marc Riquet, Pierre Magdeleinat, Guy Meyer, Nicolas Roche, Gérard Huchon, Joel Coste, Antoine Rabbat

Published in: Intensive Care Medicine | Issue 2/2014

Abstract

Objectives

To investigate whether prophylactic postoperative NIV prevents respiratory complications following lung resection surgery in COPD patients.

Methods

In seven thoracic surgery departments, 360 COPD patients undergoing lung resection surgery were randomly assigned to two groups: conventional postoperative treatment without (n = 179) or with (n = 181) prophylactic NIV, applied intermittently during 6 h per day for 48 h following surgery. The primary endpoint was the rate of acute respiratory events (ARE) at 30 days postoperatively (ITT analysis). Secondary endpoints were acute respiratory failure (ARF), intubation rate, mortality rate, infectious and non-infectious complications, and duration of ICU and hospital stay.

Measurements and main results

ARE rates did not differ between the prophylactic NIV and control groups (57/181, 31.5 vs. 55/179, 30.7 %, p = 0.93). ARF rate was 18.8 % in the prophylactic NIV group and 24.5 % in controls (p = 0.20). Re-intubation rates were similar in the prophylactic NIV and control group [10/181 (5.5 %) and 13/179 (7.2 %), respectively, p = 0.53]. Mortality rates were 5 and 2.2 % in the control and prophylactic NIV groups, respectively (p = 0.16). Infectious and non-infectious complication rates, and duration of ICU and hospital stays were similar between groups.

Conclusions

Prophylactic postoperative NIV did not reduce the rate of ARE in COPD patients undergoing lung resection surgery and did not influence other postoperative complications rates, mortality rates, and duration of ICU and hospital stay.

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Arozullah AM, Daley J, Henderson WG, Khuri SF (2000) Multifactorial risk index for predicting postoperative respiratory failure in men after noncardiac surgery. The national Vetreans administration surgical quality improvement. Ann Surg 232:242–253PubMedCrossRef

Memtsoudis SG, Besculides MC, Zellos L, Patil N, Rogers SO (2006) Trends in lung surgery: United States 1988 to 2002. Chest 130:1462–1470PubMedCrossRef

Strand TE, Rostad H, Damhuis RA, Norstein J (2007) Risk factors for 30-day mortality after resection of lung cancer and prediction of their magnitude. Thorax 62:991–997PubMedCrossRef

Watanabe S, Asamura H, Suzuki K, Tsuchiya R (2004) Recent results of postoperative mortality for surgical resections in lung cancer. Ann Thorac Surg 78:999–1002PubMedCrossRef

Dulu A, Pastores SM, Park B, Riedel E, Rish V, Halpern NA (2006) Prevalence and mortality of acute lung injury and ARDS after lung resection. Chest 130:73–78PubMedCrossRef

Schussler O, Alifano M, Dermine H, Strano S, Casseta A, Sepulveda S, Chafik A, Coignard S, Rabbat A, Regnard JF (2006) Post operative pneumonia after major lung resection. Am J Respir Crit Care Med 173:1161–1169PubMedCrossRef

Stephan F, Boucheseiche S, Hollande J, Flahault A, Cheffi A, Bazelli B, Bonnet F (2000) Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest 118:1263–1270PubMedCrossRef

Chiumello D, Chevallard G, Gregoretti C (2011) Non invasive ventilation in post operative patients. Intensive Care Med 37:918–929PubMedCrossRef

Pelosi P, Jaber S (2010) Noninvasive respiratory support in the perioperative period. Curr Opin Anaesthiol 23:233–238CrossRef

10.

Auriant J, Jallot A, Herve P, Cerrina J, Le Roy Ladurie F, Fournier JL, Lescot B, Parquin F (2001) Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med 164:117–121CrossRef

11.

Lefebvre A, Lorut C, Alifano M, Dermine H, Roche N, Gauzit R, Regnard JF, Huchon G, Rabbat A (2009) Noninvasive ventilation for acute respiratory failure after lung resection: an observational study. Intensive Care Med 35:663–670PubMedCrossRef

12.

Aguilo R, Togores B, Pons S, Rubi M, Barbe F, Agutsi A (1997) Noninvasive ventilatory support after lung resection surgery. Chest 112:117–121PubMedCrossRef

13.

Perrin C, Jullien V, Vernissac N, Berthier F, Padovani B, Guillot F, Coussement A, Mouroux J (2007) Prophylactic use of noninvasive ventilation in patients undergoing lung resection surgery. Respir Med 101:1572–1578PubMedCrossRef

14.

Liao G, Chen R, he J (2010) Prophylactic use of noninvasive positive pressure ventilation in post-thoracic surgery patients: a prospective randomized control study. J Thorac Dis 2:205–209PubMedCentralPubMed

15.

Bernard A, Ferrand L, Hagry O, Benoit L, Cheynel N, Favre JP (2000) Identification of prognostic factors determining risk groups for lung resection. Ann Thorac Surg 70:1161–1167PubMedCrossRef

16.

Lorut C, Lefebvre A, Planquette B, Clavier H, Santelmo N, Bernard A, Bellenot F, Regnard JF, Riquet M, Magdaleinat P, Meyer G, Roche N, Huchon G, Coste J, Rabbat A (2011) Noninvasive ventilatory support after lung surgery to prevent pulmonary complications in COPD patients (POPVNI trial). Eur Respir J 38:364S (Abstract)

17.

Kindgen-Milles D, Müller E, Buhl R, Böhner H, Ritter D, Sandmann W, Tarnow J (2005) Nasal-continuous positive airway pressure reduces pulmonary morbidity and length of hospital stay following thoracoabdominal aortic surgery. Chest 128:821–828PubMedCrossRef

18.

Squadrone V, Coha M, Cerutti E, Schellino MM, Biolino P, Occella P, Belloni G, Vilianis G, Fiore G, Cavallo F, Ranieeri VM (2005) Continuous positive airway pressure for treatment of postoperative hypoxemia. A randomized controlled trial. JAMA 293:589–595PubMedCrossRef

19.

Zarbock A, Mueller E, Netzer S, Gabriel A, Feindt P, Kindgen-Milles D (2009) Prophylactic nasal continuous positive airway pressure following cardiac surgery protects from postoperative pulmonary complications: a prospective, randomized, controlled trial in 500 patients. Chest 135:1252–1259PubMedCrossRef

20.

Pauwels RA, Buist AS, Caverley PM, Jenkins CR, Hurd SS, GOLD scientific committee (2001) Global strategy for the diagnosis, management and prevention of COPD. NHLBI/WHO GOLD workshop summary. Am J Respir Crit Care Med 163:1256–1276PubMedCrossRef

21.

Licker MJ, Widikker I, Robert J, Frey JG, Spiliopoulos A, Ellenberger C, Schweizer A, Tschopp JM (2006) Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends. Ann Thorac Surg 8:1830–1837CrossRef

22.

Zoremba M, Kalmus G, Begemann D, Eberhart L, Zoremba N, Wulf H, Dette F (2011) Short term non-invasive ventilation post-surgery improves arterial blood-gases in obese subjects compared to supplemental oxygen delivery-a randomized study. BMC Anesthesiol 11:10PubMedCentralPubMedCrossRef

23.

Ferrer M, Esquinas A, Arancibia F, Bauer TT, Gonzalez G, Carrillo A, Rodriguez-Roisin R, Torres A (2003) Nonivasive ventilation during persistent weaning failure: a randomized controlled trial. Am J Respir Crit Care Med 168:70–76PubMedCrossRef

24.

Jeon K, Yoon JW, Suh GY, Kim J, Kim K, Yang M, Kim H, Kwon OJ, Shim YM (2009) Risk factors for post-pneumonectomy acute lung injury/acute respiratory distress syndrome in primary lung cancer patients. Anaest Intensive Care 37:14–19

25.

Joris JL, Sottiaux TM, Chiche JD, Desaive CJ, Lamy ML (1997) Effect of bilevel positive airway pressure (BiPAP) nasal ventilation on the postoperative pulmonary restrictive syndrome in obese patients undergoing gastroplasty. Chest 111:665–670PubMedCrossRef

Title: Early postoperative prophylactic noninvasive ventilation after major lung resection in COPD patients: a randomized controlled trial
Authors: Christine Lorut
Aurélie Lefebvre
Benjamin Planquette
Laurent Quinquis
Hervé Clavier
Nicola Santelmo
Halim Abou Hanna
François Bellenot
Jean-François Regnard
Marc Riquet
Pierre Magdeleinat
Guy Meyer
Nicolas Roche
Gérard Huchon
Joel Coste
Antoine Rabbat
Publication date: 01-02-2014
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 2/2014
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-013-3150-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Early postoperative prophylactic noninvasive ventilation after major lung resection in COPD patients: a randomized controlled trial

Abstract

Objectives

Methods

Measurements and main results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Measurements and main results

Conclusions

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