title: Noninvasive positive pressure ventilation in the immediate post-bariatric surgery care of patients with obstructive sleep apnea: a systematic review.
abstract: BACKGROUND
  Obstructive sleep apnea is common in morbidly obese patients, and noninvasive positive pressure ventilation (NIPPV) is the standard treatment. Postoperatively, NIPPV is highly effective in preventing hypoxia and apneic episodes; however, the concern of gastric distention leading to increased risk of an anastomotic dehiscence limits universal acceptance.
  
  
  OBJECTIVE
  To perform a systematic review of the literature to determine if the use of NIPPV during immediate post-bariatric surgery care is safe.
  
  
  METHODS
  Between January 1, 2000 and January 1, 2015 a comprehensive literature search for English-language articles was performed. Search terms were related to NIPPV use and bariatric surgery. Three reviewers independently reviewed the full-text version of the articles for relevance. Due to lack of randomized controlled trials and common incidence of zero for leak rate, a meta-analysis was not conducted.
  
  
  RESULTS
  A total of 824 studies were identified for screening using our search criteria, and 811 were rejected based on exclusion criteria. Thirteen studies with 5465 patients were identified for abstract review. All articles were either favorable or equivocal on the use of NIPPV in this patient population. Comparative studies did not identify an increased rate of anastomotic dehiscence in the patients who did receive NIPPV. The use of NIPPV was associated with a decreased risk of respiratory complications but not of reintubation or unplanned intensive care unit admission.
  
  
  CONCLUSIONS
  This systematic review of the available literature does not provide evidence of a signal that there is an increased anastomotic dehiscence risk when NIPPV is administered during immediate post-bariatric surgery care.
authors.affiliation: Department of General Surgery, Wright State University, Dayton, Ohio.
authors.forename: Solomon
authors.initials: S
authors.lastname: Tong
authors.affiliation: Department of General Surgery, Naval Medical Center San Diego, San Diego, California.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gower
authors.affiliation: Department of General Surgery, Naval Medical Center San Diego, San Diego, California.
authors.forename: Austin
authors.initials: A
authors.lastname: Morgan
authors.affiliation: Department of General Surgery, Naval Medical Center San Diego, San Diego, California.
authors.forename: Kyle
authors.initials: K
authors.lastname: Gadbois
authors.affiliation: Department of General Surgery, Naval Medical Center San Diego, San Diego, California. Electronic address: gwisbach@gmail.com.
authors.forename: Gordon
authors.initials: G
authors.lastname: Wisbach
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology; D050110:Bariatric Surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods*; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery; D011175:Positive-Pressure Respiration / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000628:therapy*
keywords: Bariatric surgery; Obstructive sleep apnea; Positive pressure ventilation; Postoperative complications