Intraoperative prophylactic and therapeutic non-invasive ventilation: a systematic review

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Respiratory Medicine

Background:

• Non-invasive ventilation (NIV) is established for perioperative acute respiratory failure (ARF).
• Intraoperative NIV may benefit patients with difficult weaning, those refusing intubation, or requiring deep sedation.
• NIV use during surgery warrants further investigation.

Purpose of the Study:

• To evaluate the feasibility and safety of intraoperative non-invasive ventilation (NIV).
• To assess the efficacy of prophylactic and therapeutic intraoperative NIV.
• To identify patient populations that may benefit from intraoperative NIV.

Main Methods:

• A systematic review of studies using PubMed, Embase, Google Scholar, and Cochrane Library.
• Inclusion criteria: intraoperative NIV in adult patients; exclusion criteria: preoperative/postoperative use, pediatric patients, negative pressure ventilation.
• Analysis of 30 papers including 618 patients.

Main Results:

• Therapeutic intraoperative NIV for ARF in 92 patients, including 6 C-sections, resulted in uneventful surgeries.
• Prophylactic intraoperative NIV for 24 patients with respiratory limitation and 502 healthy patients under deep sedation was successful.
• Three cases of upper airway obstruction occurred, but no further complications were reported.

Conclusions:

• Intraoperative NIV appears feasible and safe for selected adult patients.
• NIV may be particularly beneficial when avoiding tracheal intubation is desired.
• High-quality randomized controlled trials are necessary to confirm these findings.