title: Prophylactic use of helmet CPAP after pulmonary lobectomy: a prospective randomized controlled study.
abstract: BACKGROUND
  Patients undergoing pulmonary lobectomy carry a high risk of respiratory complications after surgery. The postoperative prophylactic treatment with helmet CPAP may prevent postoperative acute respiratory failure and improve the P(aO(2))/F(IO(2)).
  
  
  METHODS
  We randomly allocated 50 subjects to receive continuous oxygen therapy (air-entrainment mask, F(IO(2)) 0.4) or 2 cycles of helmet CPAP for 120 min, alternating with analog oxygen therapy for 4 hours. Blood gas values were collected at admission to ICU, after 1, 3,  7, 9, 24 hours, and then in the thoracic ward after 48 hours and one week after surgery. We investigated the incidence of postoperative complications, mortality, and length of hospital stay.
  
  
  RESULTS
  At the end of the second helmet CPAP treatment, the subjects had a significantly higher P(aO(2))/F(IO(2)),  compared with the control group (366 ± 106 mm Hg vs 259 ± 60 mm Hg, P = .004), but the improvement in oxygenation did not continue beyond 24 hours. The postoperative preventive helmet CPAP treatment was associated with a significantly shorter hospital stay, in comparison  to standard treatment (7 ± 4 d and 8 ± 13 d, respectively, P = .042). The number of minor or major postoperative complications was similar between the 2 groups. No difference in ICU readmission or mortality was observed.
  
  
  CONCLUSIONS
  The prophylactic use of helmet CPAP  improved the P(aO(2))/F(IO(2)), but the oxygenation benefit was not lasting. In our study, helmet CPAP was a secure and well tolerated method in subjects who underwent pulmonary lobectomy. It might be safely applied whenever necessary.
authors.affiliation: Department of Anesthesia, Intensive Care, and Pain Therapy, University Hospital of Parma, Parma, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Barbagallo
authors.forename: Andrea
authors.initials: A
authors.lastname: Ortu
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Spadini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Salvadori
authors.forename: Luca
authors.initials: L
authors.lastname: Ampollini
authors.forename: Eveline
authors.initials: E
authors.lastname: Internullo
authors.forename: Stefanie
authors.initials: S
authors.lastname: Ziegler
authors.forename: Guido
authors.initials: G
authors.lastname: Fanelli
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001785:Blood Gas Monitoring, Transcutaneous; D016009:Chi-Square Distribution; D045422:Continuous Positive Airway Pressure; D003422:Critical Care; D005260:Female; D006801:Humans; D007902:Length of Stay; D008168:Lung / Q000502:physiology / Q000601:surgery*; D008297:Male; D008397:Masks; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000517:prevention & control*; D018709:Statistics, Nonparametric; D055815:Young Adult