Effect of bi-level positive airway pressure (BiPAP) nasal ventilation on the postoperative pulmonary restrictive syndrome in obese patients undergoing gastroplasty.
[en] STUDY OBJECTIVE: Upper abdominal surgery results in a postoperative restrictive pulmonary syndrome. Bi-level positive airway pressure (BiPAP System; Respironics Inc; Murrysville, Pa), which combines pressure support ventilation and positive end-expiratory pressure via a nasal mask, could allow alveolar recruitment during inspiration and prevent expiratory alveolar collapse, and therefore limit the postoperative pulmonary restrictive syndrome. This study investigated the effect of BiPAP on postoperative pulmonary function in obese patients after gastroplasty. DESIGN: Prospective controlled randomized study. SETTING: GI surgical ward in a university hospital. PATIENTS: Thirty-three morbidly obese patients scheduled for gastroplasty were studied. INTERVENTION: The patients were assigned to one of three techniques of ventilatory support during the first 24 h postoperatively: O2 via a face mask, BiPAP System 8/4, with inspiratory and expiratory positive airway pressure set at 8 and 4 cm H2O, respectively, or BiPAP System 12/4 set at 12 and 4 cm H2O. Pulmonary function (FVC, FEV1, and peak expiratory flow rate [PEFR]) were measured the day before surgery, 24 h after surgery, and on days 2 and 3. Oxygen saturation by pulse oximeter (SpO2) was also recorded during room air breathing. RESULTS: Three patients were excluded. After surgery, FVC, FEV1, PEFR, and SpO2 significantly decreased in the three groups. On day 1, FVC and FEV1 were significantly improved in the group BiPAP System 12/4, as compared with no BiPAP; SpO2 was also significantly improved. After removal of BiPAP System 12/4, these benefits were maintained, allowing faster recovery of pulmonary function. No significant effects were observed on PEFR. BiPAP System 8/4 had no significant effect on the postoperative pulmonary restrictive syndrome. CONCLUSION: Prophylactic use of BiPAP System 12/4 during the first 24 h postoperatively significantly reduces pulmonary dysfunction after gastroplasty in obese patients and accelerates reestablishment of preoperative pulmonary function.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Joris, Jean ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Sottiaux, Thierry
Chiche, Jean-Daniel
Desaive, Claude ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Lamy, Maurice ; Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
Language :
English
Title :
Effect of bi-level positive airway pressure (BiPAP) nasal ventilation on the postoperative pulmonary restrictive syndrome in obese patients undergoing gastroplasty.
Publication date :
1997
Journal title :
CHEST
ISSN :
0012-3692
eISSN :
1931-3543
Publisher :
American College of Chest Physicians, Northbrook, United States - Illinois
Clergue F, Pansard JL. Respiratory changes induced by upper abdominal and cardiac surgery. In: Vincent JL, ed. Update in intensive care and emergency medicine. Berlin: Springer-Verlag, 1990; 166-73
Hedenstierna G. Mechanisms of postoperative pulmonary dysfunction. Acta Chir Scand 1988; 550:152-58
Ford GT, Rosenal TW, Clergue F, et al. Respiratory physiology in upper abdominal surgery. Clin Chest Med 1993; 14:237-52
Jayr C, Thomas H, Rev A, et al. Postoperative pulmonary complications: epidural analgesia using bupivacaine and opioids versus parenteral opioids. Anesthesiology 1993; 78: 666-76
Oikkonen M, Karjalainen K, Kähärä V, et al. Comparison of incentive spirometry and intermittent positive pressure breathing after coronary artery bypass graft. Chest 1991; 99:60-5
Celli BR. Perioperative respiratory care of the patient undergoing upper abdominal surgery. Clin Chest Med 1993; 14:253-61
Stock MC, Downs JB, Corkran ML. Pulmonary function before and after prolonged continuous positive airway pressure by mask. Crit Care Med 1984; 12:973-74
Lindner KH, Lotz P, Ahnefeld FW. Continuous positive airway pressure effect on functional residual capacity, vital capacity and its subdivisions. Chest 1987; 92:66-70
Pinilla JC, Oleniuk FH, Tan L, et al. Use of a nasal continuous positive airway pressure mask in the treatment of postoperative atelectasis in aortocoronary bypass surgery. Crit Care Med 1990; 18:836-40
Martin JG, Shore S, Engel LA. Effect of continuous positive airway pressure on respiratory mechanics and pattern of breathing in induced asthma. Am Rev Respir Dis 1982; 126:812-17
Ricksten SE, Bengtsson A, Soderberg C, et al. Effects of periodic positive airway pressure by mask on postoperative pulmonary function. Chest 1986; 89:774-81
Strumpf DA, Carlisle CC, Millman RP, et al. An evaluation of the Respironics BiPAP Bi-Level CPAP device for delivery of assisted ventilation. Respir Care 1990; 35:415-22
Sanders MH, Kern N. Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressures via nasal mask: physiologic and clinical implications. Chest 1990; 98:317-24
Waldhorn RE. Nocturnal nasal intermittent positive pressure ventilation with bi-level positive airway pressure (BiPAP) in respiratory failure. Chest 1992; 101:516-21
Nava S, Ambrosino N, Rubini F, et al. Effect of nasal pressure support ventilation and external PEEP on diaphragmatic activity in patients with severe stable COPD. Chest 1993; 103:143-50
Ambrosino N, Nava S, Bertone P, et al. Physiologic evaluation of pressure support ventilation by nasal mask in patients with stable COPD. Chest 1992; 101:385-91
Bach JR. Management of neuromuscular ventilatory failure by 24 hours non-invasive intermittent positive pressure ventilation. Eur Respir Rev 1993; 3:284-91
Hill NS, Eveloff SE, Carlisle CC, et al. Efficacy of nocturnal nasal ventilation in patients with restrictive thoracic disease. Am Rev Respir Dis 1992; 145:365-71
Meduri GU, Abou-Shala N, Fox RC, et al. Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure. Chest 1991; 100:445-54
Pennock BE, Kaplan PD, Carlin BW, et al. Pressure support ventilation with a simplified ventilalory support system administered with a nasal mask in patients with respiratory failure. Chest 1991; 100:1371-76
Vitacca M, Rubini F, Foglio K, et al. Non-invasive modalities of positive pressure ventilation improve the outcome of acute exacerbations in COPD patients. Intensive Care Med 1993; 19:450-55
Al-Saady N, Bennett ED. Decelerating inspiratory flow waveform improves lung mechanics and gas exchange in patients on intermittent positive-pressure ventilation. Intensive Care Med 1985; 11:68-75
Chan K, Abraham E. Effects of inverse ratio ventilation on cardiopulmonary parameters in severe respiratory failure. Chest 1992; 102:1556-61
Ravenscraft SA, Burke WC, Marini JJ. Volume-cycled decelerating flow: an alternative form of mechanical ventilation. Chest 1992; 101:1342-51
Brochard L, Isabey D, Piquet J, et al. Reversal of exacerbations of chronic obstructive lung disease by inspiratory assistance with a face mask. N Engl J Med 1990; 323:1523-30
Hall JC, Tarala RA, Hall JL, et al. A mnltivariable analysis of the risk of pulmonary complications after laparotomy. Chest 1991; 99:923-27
Johnson D, Litwin D, Osachoff J, et al. Postoperative respiratory function after laparoscopic cholecystectomy. Surg Luparose Endosc 1992; 2:221-26
Laws H. Standardized gastroplasty orifice. Am J Surg 1981; 141:393-94
Hess DR, Kacmarek RM. Modes of mechanical ventilation. In: Essentials of mechanical ventilation. New York: McGraw-Hill, 1996; 17-23
Schulze S, Sommer P, Bigler D, et al. Effect of combined prednisolone, epidural analgesia and indomethacin on the systemic response alter colonic surgery. Arch Surg 1992; 127:325-31
Carrey Z, Gottfried SB, Levy RD. Ventilatory muscle support in respiratory failure with nasal positive pressure ventilation. Chest 1990; 97:150-58
Brochard L. Pressure support ventilation. Intensive Care World 1989; 6:12-4
Foglio C, Vittaca M, Onadri A, et al. Acute exacerbations in severe COLD patients: treatment using positive ventilation by nasal mask. Chest 1992; 101:1533-38
Marino W. Intermittent volume cycled mechanical ventilation via nasal mask in patients with respiratory failure due to COPD. Chest 1991; 99:681-84
Sottiaux T. Nasal mask ventilation in acute respiratory failure [letter]. Chest 1993; 104:1315-16
