OBJECTIVE: We evaluated the potential benefit of continuous positive airway pressure (CPAP) to prevent postoperative pulmonary complications (PPCs), atelectasis, pneumonia, and intubation in patients undergoing major abdominal surgery. SUMMARY BACKGROUND DATA: PPCs are common during the postoperative period and may be associated with a high morbidity rate. Efficacy of CPAP to prevent PPCs occurrence is controversial. METHODS: Medical literature databases were searched for randomized controlled trials examining the use of CPAP versus standard therapy in patients undergoing abdominal surgery. The meta-analysis estimated the pooled risk ratio and the number needed to treat to benefit (NNTB) for PPCs, atelectasis, and pneumonia. RESULTS: The meta-analysis was carried out over 9 randomized controlled trials. Overall, CPAP significantly reduced the risk of (1) PPCs (risk ratio, 0.66; 95% confidence interval [CI], 0.52-0.85) with a corresponding NNTB of 14.2 (95% CI, 9.9-32.4); (2) atelectasis (risk ratio, 0.75; 95% CI, 0.58-0.97; NNTB, 7.3; 95% CI, 4.4-64.5); (3) pneumonia (risk ratio, 0.33; 95% CI, 0.14-0.75; NNTB, 18.3; 95% CI, 14.4-48.8). In all cases the variation in risk ratio attributable to heterogeneity was negligible, although there was some evidence of publication bias. CONCLUSIONS: This systematic review suggests that CPAP decreases the risk of PPCs, atelectasis, and pneumonia and supports its clinical use in patients undergoing abdominal surgery.
OBJECTIVE: We evaluated the potential benefit of continuous positive airway pressure (CPAP) to prevent postoperative pulmonary complications (PPCs), atelectasis, pneumonia, and intubation in patients undergoing major abdominal surgery. SUMMARY BACKGROUND DATA: PPCs are common during the postoperative period and may be associated with a high morbidity rate. Efficacy of CPAP to prevent PPCs occurrence is controversial. METHODS: Medical literature databases were searched for randomized controlled trials examining the use of CPAP versus standard therapy in patients undergoing abdominal surgery. The meta-analysis estimated the pooled risk ratio and the number needed to treat to benefit (NNTB) for PPCs, atelectasis, and pneumonia. RESULTS: The meta-analysis was carried out over 9 randomized controlled trials. Overall, CPAP significantly reduced the risk of (1) PPCs (risk ratio, 0.66; 95% confidence interval [CI], 0.52-0.85) with a corresponding NNTB of 14.2 (95% CI, 9.9-32.4); (2) atelectasis (risk ratio, 0.75; 95% CI, 0.58-0.97; NNTB, 7.3; 95% CI, 4.4-64.5); (3) pneumonia (risk ratio, 0.33; 95% CI, 0.14-0.75; NNTB, 18.3; 95% CI, 14.4-48.8). In all cases the variation in risk ratio attributable to heterogeneity was negligible, although there was some evidence of publication bias. CONCLUSIONS: This systematic review suggests that CPAP decreases the risk of PPCs, atelectasis, and pneumonia and supports its clinical use in patients undergoing abdominal surgery.
Authors: Maurizio De Luca; Luigi Angrisani; Jacques Himpens; Luca Busetto; Nicola Scopinaro; Rudolf Weiner; Alberto Sartori; Christine Stier; Muffazal Lakdawala; Aparna G Bhasker; Henry Buchwald; John Dixon; Sonja Chiappetta; Hans-Christian Kolberg; Gema Frühbeck; David B Sarwer; Michel Suter; Emanuele Soricelli; Mattias Blüher; Ramon Vilallonga; Arya Sharma; Scott Shikora Journal: Obes Surg Date: 2016-08 Impact factor: 4.129