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Pettenuzzo T, Boscolo A, Pistollato E, Pretto C, Giacon TA, Frasson S, Carbotti FM, Medici F, Pettenon G, Carofiglio G, Nardelli M, Cucci N, Tuccio CL, Gagliardi V, Schiavolin C, Simoni C, Congedi S, Monteleone F, Zarantonello F, Sella N, De Cassai A, Navalesi P. Effects of non-invasive respiratory support in post-operative patients: a systematic review and network meta-analysis. Crit Care 2024; 28:152. [PMID: 38720332 PMCID: PMC11077852 DOI: 10.1186/s13054-024-04924-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/21/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Re-intubation secondary to post-extubation respiratory failure in post-operative patients is associated with increased patient morbidity and mortality. Non-invasive respiratory support (NRS) alternative to conventional oxygen therapy (COT), i.e., high-flow nasal oxygen, continuous positive airway pressure, and non-invasive ventilation (NIV), has been proposed to prevent or treat post-extubation respiratory failure. Aim of the present study is assessing the effects of NRS application, compared to COT, on the re-intubation rate (primary outcome), and time to re-intubation, incidence of nosocomial pneumonia, patient discomfort, intensive care unit (ICU) and hospital length of stay, and mortality (secondary outcomes) in adult patients extubated after surgery. METHODS A systematic review and network meta-analysis of randomized and non-randomized controlled trials. A search from Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science from inception until February 2, 2024 was performed. RESULTS Thirty-three studies (11,292 patients) were included. Among all NRS modalities, only NIV reduced the re-intubation rate, compared to COT (odds ratio 0.49, 95% confidence interval 0.28; 0.87, p = 0.015, I2 = 60.5%, low certainty of evidence). In particular, this effect was observed in patients receiving NIV for treatment, while not for prevention, of post-extubation respiratory failure, and in patients at high, while not low, risk of post-extubation respiratory failure. NIV reduced the rate of nosocomial pneumonia, ICU length of stay, and ICU, hospital, and long-term mortality, while not worsening patient discomfort. CONCLUSIONS In post-operative patients receiving NRS after extubation, NIV reduced the rate of re-intubation, compared to COT, when used for treatment of post-extubation respiratory failure and in patients at high risk of post-extubation respiratory failure.
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Affiliation(s)
- Tommaso Pettenuzzo
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
| | - Annalisa Boscolo
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Elisa Pistollato
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Chiara Pretto
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | | | - Sara Frasson
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | | | - Francesca Medici
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Giovanni Pettenon
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Giuliana Carofiglio
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Marco Nardelli
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Nicolas Cucci
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Clara Letizia Tuccio
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Veronica Gagliardi
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Chiara Schiavolin
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Caterina Simoni
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Sabrina Congedi
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Francesco Monteleone
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Francesco Zarantonello
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
| | - Nicolò Sella
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
| | - Alessandro De Cassai
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
| | - Paolo Navalesi
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy.
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy.
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Hackett C, Denehy L, Kruger P, Ripley N, Reid N, Smithers BM, Walker RM, Hope L, Boden I. PHYSIO+++: protocol for a pilot randomised controlled trial assessing the feasibility of physiotherapist-led non-invasive ventilation for patients with hypoxaemia following abdominal surgery. BMJ Open 2023; 13:e078175. [PMID: 38101825 PMCID: PMC11148710 DOI: 10.1136/bmjopen-2023-078175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Few clinical trials have investigated physiotherapy interventions to treat hypoxaemia following abdominal surgery. The objective of this study is to determine the feasibility and safety of conducting a clinical trial of physiotherapist-led non-invasive ventilation (NIV). METHODS AND ANALYSIS This single-centre, 50-patient, parallel-group, assessor blinded, pilot feasibility randomised controlled trial with concealed allocation will enrol spontaneously ventilating adults with hypoxaemia within 72 hours of major abdominal surgery. Participants will receive either (1) usual care physiotherapy of a single education session (talk), daily walking of 10-15 min (walk) and four sessions of coached deep breathing and coughing (breathe) or (2) usual care physiotherapy plus four 30 min sessions of physiotherapist-led NIV delivered over 2 postoperative days. Primary feasibility and safety outcome measures are; number of eligible patients recruited per week, total time of NIV treatment delivered, acceptability of treatments to patients and clinicians and incidence of adverse events. Secondary feasibility outcomes include measures of recruitment and treatment adherence. Exploratory outcome measures include change in respiratory parameters, postoperative pulmonary complications, length of hospital stay, health-related quality of life, postoperative activity levels and mortality. ETHICS AND DISSEMINATION Ethics approval has been obtained from the relevant institution. Results will be published to inform future research. TRIAL REGISTRATION NUMBER ACTRN12622000839707.
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Affiliation(s)
- Claire Hackett
- Department of Physiotherapy, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Linda Denehy
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Peter Kruger
- Department of Intensive Care, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - Nina Ripley
- Department of Physiotherapy, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Natasha Reid
- Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - B Mark Smithers
- Upper Gastro-intestinal Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Discipline of Surgery, The School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachel M Walker
- Division of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Louise Hope
- Consumer representative, Brisbane, Queensland, Australia
| | - Ianthe Boden
- School of Health Science, University of Tasmania, Launceston, Tasmania, Australia
- Department of Physiotherapy, Launceston General Hospital, Launceston, Tasmania, Australia
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Prophylactic Postoperative Noninvasive Ventilation in Adults Undergoing Upper Abdominal Surgery: A Systematic Review and Meta-Analysis. Crit Care Med 2022; 50:1522-1532. [PMID: 35881511 DOI: 10.1097/ccm.0000000000005628] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Postoperative pulmonary complications (PPCs) are a leading cause of morbidity and mortality following upper abdominal surgery. Applying either noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP) in the early postoperative period is suggested to prevent PPC. We aimed to assess whether postoperative NIV or CPAP or both prevent PPCs compared with standard care in adults undergoing upper abdominal surgery, including in those identified at higher PPC risk. Additionally, the different interventions used were evaluated to assess whether there is a superior approach. DATA SOURCES We searched PubMed, Embase' CINAHL, CENTRAL, and Scopus from inception to May 17, 2021. STUDY SELECTION We performed a systematic search of the literature for randomized controlled trials evaluating prophylactic NIV and/or CPAP in the postoperative period. DATA EXTRACTION Two authors independently performed study selection and data extraction. Individual study risk of bias was assessed using the PEDro scale, and certainty in outcomes was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. DATA SYNTHESIS We included 17 studies enrolling 6,108 patients. No significant benefit was demonstrated for postoperative NIV/CPAP to reduce PPC (risk ratio [RR], 0.89; 95% CI, 0.78-1.01; very low certainty), including in adults identified at higher PPC risk (RR, 0.91; 95% CI, 0.77-1.07; very low certainty). No intervention approach was identified as superior, and no significant benefit was demonstrated when comparing: 1) CPAP (RR, 0.90; 95% CI, 0.79-1.04; very low certainty), 2) NIV (RR, 0.68; 95% CI, 0.41-1.13; very low certainty), 3) continuous NIV/CPAP (RR, 0.90; 95% CI, 0.77-1.05; very low certainty), or 4) intermittent NIV/CPAP (RR, 0.66; 95% CI, 0.39-1.10; very low certainty) to standard care. CONCLUSIONS These findings suggest routine provision of either prophylactic NIV or CPAP following upper abdominal surgery may not be effective to reduce PPCs' including in those identified at higher risk.
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