Prophylactic nasal continuous positive airway pressure after major vascular surgery: results of a prospective randomized trial.
BACKGROUND
The efficacy of nasal continuous positive airway pressure (nCPAP) as a prophylactic method for preventing cardiopulmonary complications after major vascular surgery has not been investigated.


METHODS
In a prospective randomized trial, 204 patients undergoing elective midline laparotomy for vascular surgery were randomized to receive standard therapy ( n=105) or additional prophylactic nCPAP ( n=99) for the first postoperative night. Postoperative oxygenation, incidence of severe cardiac, and pulmonary complications, length of intensive care surveillance and length of total postoperative hospital stay (LOS) were compared.


RESULTS
Prophylactic nCPAP significantly reduced the number of patients with severe oxygenation disturbances defined as paO(2) < 70 mmHg with FiO(2) > or = 0.7 (5 versus 17, P=.01). There were no differences with respect to death, cardiac and pulmonary complications, length of intensive care surveillance or LOS.


CONCLUSIONS
Prophylactic 12 h nCPAP significantly reduces the occurrence of postoperative oxygenation disturbances but has no effect on cardiac or pulmonary complications, need for intensive care, LOS or mortality after major vascular surgery.
Böhner
Hinrich
H
Department of Vascular Surgery and Kidney Transplantation, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany. Boehner@med.uni-duesseldorf.de
Kindgen-Milles
Detlef
D
Grust
Andreas
A
Buhl
Rolf
R
Lillotte
Wolf-Christian
WC
Müller
Barbara T
BT
Müller
Eckhard
E
Fürst
Günter
G
Sandmann
Wilhelm
W
D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000517:prevention & control*; D014656:Vascular Surgical Procedures / Q000534:rehabilitation*