title: Prevention of pulmonary complications after aortic surgery: evaluation of prophylactic noninvasive perioperative ventilation.
abstract: BACKGROUND
  In 40% of the cases, pulmonary complications are encountered after aortic surgery in patients suffering from chronic obstructive broncho-pneumopathy (COBP). The factors aggravating the occurrence of these complications are cumulated tobacco addiction of ≥40 packets per year and surgery for aneurysm. The aim of our prospective study was to evaluate the effect of pre- and postoperative noninvasive ventilation (NIV) preparation on the respiratory function of patients presenting with high pulmonary risks.
  
  
  METHODS
  Between September 2007 and May 2010, 30 patients were included in the present study. Inclusions criteria were male gender, patients suffering from COBP with tobacco addiction of ≥40 packets per year, and aortic surgery for aneurysm with or without occlusive lesions. In all, 14 of the 15 patients had effectively performed the preparation before and after surgery according to a fixed protocol (NIV group). We compared the respiratory rate complications and the mean hospital length of stay in intensive care with the non-NIV control group (15 patients).
  
  
  RESULTS
  Mean age, severity of COBP according to the classification of the French Society for Pneumology, surgery duration, and blood losses were comparable between the two groups. Conversely, pulmonary complications were significantly lower in the NIV group (0/14 [0%] vs. 5/15 [33%], p = 0.004). Hospital length of stay in intensive care was shorter in the NIV group (2.5 vs. 6.5 days, p < 0.001).
  
  
  CONCLUSIONS
  Preliminary results are encouraging, in favor of pulmonary preparation before aortic surgery with NIV at home, and carried on postoperatively in hospital for patients with COBP. These results prompt us to propose a multicenter study to validate these first observations.
authors.affiliation: Service de Chirurgie Vasculaire et Thoracique, CH Victor Dupouy, Argenteuil, France. patrick.bagan@ch-argenteuil.fr
authors.forename: Patrick
authors.initials: P
authors.lastname: Bagan
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bouayad
authors.forename: Ali
authors.initials: A
authors.lastname: Benabdesselam
authors.forename: Alain
authors.initials: A
authors.lastname: Landais
authors.forename: Hervé
authors.initials: H
authors.lastname: Mentec
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Couffinhal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D001018:Aortic Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016022:Case-Control Studies; D005602:France; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008171:Lung Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D012121:Respiration, Artificial; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality