Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial.
BACKGROUND
Hypoxemia complicates the recovery of 30% to 50% of patients after abdominal surgery; endotracheal intubation and mechanical ventilation may be required in 8% to 10% of cases, increasing morbidity and mortality and prolonging intensive care unit and hospital stay.


OBJECTIVE
To determine the effectiveness of continuous positive airway pressure compared with standard treatment in preventing the need for intubation and mechanical ventilation in patients who develop acute hypoxemia after elective major abdominal surgery.


METHODS
Randomized, controlled, unblinded study with concealed allocation conducted between June 2002 and November 2003 at 15 intensive care units of the Piedmont Intensive Care Units Network in Italy.


METHODS
Consecutive patients who developed severe hypoxemia after major elective abdominal surgery. The trial was stopped for efficacy after 209 patients had been enrolled.


METHODS
Patients were randomly assigned to receive oxygen (n = 104) or oxygen plus continuous positive airway pressure (n = 105).


METHODS
The primary end point was incidence of endotracheal intubation; secondary end points were intensive care unit and hospital lengths of stay, incidence of pneumonia, infection and sepsis, and hospital mortality.


RESULTS
Patients who received oxygen plus continuous positive airway pressure had a lower intubation rate (1% vs 10%; P = .005; relative risk [RR], 0.099; 95% confidence interval [CI], 0.01-0.76) and had a lower occurrence rate of pneumonia (2% vs 10%, RR, 0.19; 95% CI, 0.04-0.88; P = .02), infection (3% vs 10%, RR, 0.27; 95% CI, 0.07-0.94; P = .03), and sepsis (2% vs 9%; RR, 0.22; 95% CI, 0.04-0.99; P = .03) than did patients treated with oxygen alone. Patients who received oxygen plus continuous positive airway pressure also spent fewer mean (SD) days in the intensive care unit (1.4 [1.6] vs 2.6 [4.2], P = .09) than patients treated with oxygen alone. The treatments did not affect the mean (SD) days that patients spent in the hospital (15 [13] vs 17 [15], respectively; P = .10). None of those treated with oxygen plus continuous positive airway pressure died in the hospital while 3 deaths occurred among those treated with oxygen alone (P = .12).


CONCLUSIONS
Continuous positive airway pressure may decrease the incidence of endotracheal intubation and other severe complications in patients who develop hypoxemia after elective major abdominal surgery.
Squadrone
Vincenzo
V
Dipartimento di Anestesia, Azienda Ospedaliera S.Giovanni Battista-Molinette, Università di Torino, Italy.
Coha
Massimiliano
M
Cerutti
Elisabetta
E
Schellino
Maria Maddalena
MM
Biolino
Piera
P
Occella
Paolo
P
Belloni
Giuseppe
G
Vilianis
Giuseppe
G
Fiore
Gilberto
G
Cavallo
Franco
F
Ranieri
V Marco
VM
D000368:Aged; D000768:Anesthesia, General; D045422:Continuous Positive Airway Pressure; D003422:Critical Care; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000628:therapy*; D007442:Intubation, Intratracheal; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D011183:Postoperative Complications / Q000628:therapy*; D011446:Prospective Studies