Noninvasive respiratory support in the perioperative period

The aims of this review are: to discuss the physiological rationale for noninvasive respiratory support (NRS) in the perioperative period; to give some practical recommendations to safely apply NRS; and to review available clinical data on preventive and curative NRS after cardiac, thoracic and abdominal surgery.

The most important morbid postoperative pulmonary complication is atelectasis formation, which increases significantly the risk for pneumonia and hypoxic acute respiratory failure. NRS refers to techniques allowing respiratory support without the need for an invasive airway. Two types of NRS are commonly used: noninvasive continuous positive airway pressure (nCPAP) and noninvasive positive pressure ventilation (nPPV). NRS may be an important tool to prevent (prophylactic treatment) or to treat acute respiratory failure avoiding intubation (curative treatment). The aims of NRS are: to partially compensate for the affected respiratory function by reducing the work of breathing; to improve alveolar recruitment with better gas exchange (oxygenation and ventilation); to reduce left ventricular afterload, increasing cardiac output and improving hemodynamics. Evidence suggests that NRS has been proven to be an effective strategy to reduce intubation rates, nosocomial infections, ICU and hospital lengths of stay, morbidity and mortality in postoperative patients. However, before initiating NRS any surgical complications must be treated.

The application of postoperative NRS by a trained and experienced ICU team, with careful patient selection, should optimize patient outcome.