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The effect of immediate postoperative Boussignac CPAP on adverse pulmonary events after thoracic surgery: A
Luis Puente-Maestú1, Eloísa López, Javier Sayas
1From the Servicio de Neumología Hospital General Universitario Gregorio Marañón (LP-M), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) (LP-M, IG), Facultad de Medicina Universidad Complutense de Madrid (UCM) (LP-M, EL, JS, IG), Servicio de Anestesia Hospital General Universitario Gregorio Marañón (IG), Servicio de Anestesia Hospital General Universitario 12 de Octubre (EL), Instituto de Investigación Sanitaria 12 de Octubre (I+12) (EL, JS), Servicio de Neumología Hospital General Universitario 12 de Octubre (JS), Servicio de Anestesia Hospital General Universitario La Princesa (EA, AP), Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS La Princea) (EA, AP), Facultad de Medicina Universidad Autónoma de Madrid (UAM) (EA, AP), Servicio de Anestesia Hospital General Universitario Ramón y Cajal (DJP, MM-B), Instituto de Investigación Sanitaria Hospital Ramón y Cajal (IRICYS) (DJP, MM-B), Facultad de Medicina Universidad de Alcalá de Henares (UAH), Madrid, Spain (DJP, MM-B).
Background:
The effectiveness of prophylactic continuous positive pressure ventilation (CPAP) after thoracic surgery is not clearly established.
Objective:
The aim of this study was to assess the effectiveness of CPAP immediately after lung resection either by thoracotomy or thoracoscopy in preventing atelectasis and pneumonia.
Design:
A multicentre, randomised, controlled, open-label trial.
Settings:
Four large University hospitals at Madrid (Spain) from March 2014 to December 2016.
Patients:
Immunocompetent patients scheduled for lung resection, without previous diagnosis of sleep-apnoea syndrome or severe bullous emphysema. Four hundred and sixty-four patients were assessed, 426 were randomised and 422 were finally analysed.
Intervention:
Six hours of continuous CPAP through a Boussignac system versus standard care.
Main Outcome Measures:
Primary outcome: incidence of the composite endpoint 'atelectasis + pneumonia'. Secondary outcome: incidence of the composite endpoint 'persistent air leak + pneumothorax'.
Results:
The primary outcome occurred in 35 patients (17%) of the CPAP group and in 58 (27%) of the control group [adjusted relative risk (ARR) 0.53, 95% CI 0.30 to 0.93]. The secondary outcome occurred in 33 patients (16%) of the CPAP group and in 29 (14%) of the control group [ARR 0.92, 95% CI 0.51 to 1.65].
Conclusion:
Prophylactic CPAP decreased the incidence of the composite endpoint 'postoperative atelectasis + pneumonia' without increasing the incidence of the endpoint 'postoperative persistent air leaks + pneumothorax'.
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