Christine Lorut1, Aurélie Lefebvre2, Benjamin Planquette3, Laurent Quinquis4, Hervé Clavier5, Nicola Santelmo6, Halim Abou Hanna7, François Bellenot8, Jean-François Regnard9, Marc Riquet10, Pierre Magdeleinat11, Guy Meyer3, Nicolas Roche2, Gérard Huchon2, Joel Coste4, Antoine Rabbat2. 1. Service de pneumologie et USIR, Department of Respiratory and Intensive Care Medicine, Cochin-Broca-Hôtel-Dieu Hospital Group, Site Cochin, AP-HP, University Paris5, René Descartes, 27 rue du Faubourg Saint Jacques, 75679, Paris cedex 14, France. christine.lorut@cch.aphp.fr. 2. Service de pneumologie et USIR, Department of Respiratory and Intensive Care Medicine, Cochin-Broca-Hôtel-Dieu Hospital Group, Site Cochin, AP-HP, University Paris5, René Descartes, 27 rue du Faubourg Saint Jacques, 75679, Paris cedex 14, France. 3. Department of Respiratory and Intensive Care Medicine, European Georges Pompidou Hospital, AP-HP, University Paris5, René Descartes, Paris, France. 4. Department of Biostatistics and Epidemiology, Hôtel-Dieu Hospital, AP-HP, University Paris5, René Descartes, Paris, France. 5. Department of intensive care Medicine, Institut Montsouris Hospital, Paris, France. 6. Department of Thoracic Surgery, University Hospital, Strasbourg, France. 7. Department of Thoracic Surgery, University Hospital, Dijon, France. 8. Department of Thoracic Surgery, University Hospital, Pontoise, France. 9. Department of Thoracic Surgery, Cochin-Broca-Hôtel-Dieu Hospital Group, AP-HP, University Paris5, René Descartes, Paris, France. 10. Department of Thoracic Surgery, European Georges Pompidou Hospital, AP-HP, University Paris5, René Descartes, Paris, France. 11. Department of Thoracic Surgery, Institut Montsouris Hospital, Paris, France.
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.
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.
Authors: Olivier Schussler; Marco Alifano; Herve Dermine; Salvatore Strano; Anne Casetta; Sergio Sepulveda; Aziz Chafik; Sophie Coignard; Antoine Rabbat; Jean-François Regnard Journal: Am J Respir Crit Care Med Date: 2006-02-10 Impact factor: 21.405