title: Non-invasive ventilation in postoperative patients: a systematic review.
abstract: BACKGROUND
  Postoperative pulmonary complications, generally defined as any pulmonary abnormality occurring in the postoperative period, are still a significant issue in clinical practice increasing hospital length of stay, morbidity and mortality. Non-invasive ventilation (NIV), primarily applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic pulmonary failure, is nowadays also used in perioperative settings.
  
  
  OBJECTIVE
  Investigate the application and results of preventive and therapeutic NIV in postsurgical patients.
  
  
  METHODS
  A systematic review.
  
  
  METHODS
  Medical literature databases were searched for articles about "clinical trials," "randomized controlled trials" and "meta-analyses." The keywords "cardiac surgery," "thoracic surgery," "lung surgery," "abdominal surgery," "solid organ transplantation," "thoraco-abdominal surgery" and "bariatric surgery" were combined with any of these: "non-invasive positive pressure ventilation," "continuous positive airway pressure," "bilevel ventilation," "postoperative complications," "postoperative care," "respiratory care," "acute respiratory failure," "acute lung injury" and "acute respiratory distress syndrome."
  
  
  RESULTS
  Twenty-nine articles (N=2,279 patients) met the inclusion criteria. Nine studies evaluated NIV in post-abdominal surgery, three in thoracic surgery, eight in cardiac surgery, three in thoraco-abdominal surgery, four in bariatric surgery and two in post solid organ transplantation used both for prophylactic and therapeutic purposes. NIV improved arterial blood gases in 15 of the 22 prophylactic and in 4 of the 7 therapeutic studies, respectively. NIV reduced the intubation rate in 11 of the 29 studies and improved outcome in only 1.
  
  
  CONCLUSIONS
  Despite these limited data and the necessity of new randomized trials, NIV could be considered as a prophylactic and therapeutic tool to improve gas exchange in postoperative patients.
authors.affiliation: U.O. Anestesia e Rianimazione, Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy. chiumello@libero.it
authors.forename: D
authors.initials: D
authors.lastname: Chiumello
authors.forename: G
authors.initials: G
authors.lastname: Chevallard
authors.forename: C
authors.initials: C
authors.lastname: Gregoretti
mesh_terms: D006801:Humans; D007362:Intensive Care Units; D011175:Positive-Pressure Respiration; D011182:Postoperative Care