Journal Article

Early postoperative prophylactic noninvasive ventilation after major lung resection in COPD patients: a randomized controlled trial

Jean-François Regnard, Laurent Quinquis, Benjamin Planquette, Joël Coste, Nicola Santelmo, Guy Meyer, Gérard Huchon, Francois Bellenot, Marie-Pierre Revel, Aurélie Lefebvre, Pierre Magdeleinat, Antoine Rabbat, Christine Lorut, Nicolas Roche, Marc Riquet, Halim Abou Hanna, Herve Clavier

2014

Overview

Objectives To investigate whether prophylactic postoperative NIV prevents respiratory complications following lung resection surgery in COPD patients. Methods In seven thoracic surgery departments, 360 COPD patients undergoing lung resection surgery were randomly assigned to two groups: conventional postoperative treatment without ( n  = 179) or with ( n  = 181) prophylactic NIV, applied intermittently during 6 h per day for 48 h following surgery. The primary endpoint was the rate of acute respiratory events (ARE) at 30 days postoperatively (ITT analysis). Secondary endpoints were acute respiratory failure (ARF), intubation rate, mortality rate, infectious and non-infectious complications, and duration of ICU and hospital stay. Measurements and main results ARE rates did not differ between the prophylactic NIV and control groups (57/181, 31.5 vs. 55/179, 30.7 %, p  = 0.93). ARF rate was 18.8 % in the prophylactic NIV group and 24.5 % in controls ( p  = 0.20). Re-intubation rates were similar in the prophylactic NIV and control group [10/181 (5.5 %) and 13/179 (7.2 %), respectively, p  = 0.53]. Mortality rates were 5 and 2.2 % in the control and prophylactic NIV groups, respectively ( p  = 0.16). Infectious and non-infectious complication rates, and duration of ICU and hospital stays were similar between groups. Conclusions Prophylactic postoperative NIV did not reduce the rate of ARE in COPD patients undergoing lung resection surgery and did not influence other postoperative complications rates, mortality rates, and duration of ICU and hospital stay.

• Publisher: Springer Science and Business Media LLC,Springer Berlin Heidelberg,Springer,Springer Nature B.V
• Subject: Acute respiratory distress syndrome / Analysis / Anesthesiology / Care and treatment / Chronic obstructive pulmonary disease / Clinical trials / Critical Care Medicine / Emergency Medicine / Feasibility Studies / Female / France / Health aspects / Humans / Intensive / Intensive care / Intubation / Lung Diseases / Lung Diseases - prevention & control / Lung diseases, Obstructive / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Middle Aged / Mortality / Noninvasive Ventilation / Original Article / Pain Medicine / Pediatrics / Pneumology/Respiratory System / Pneumonectomy / Pneumonectomy - methods / Postoperative Care / Postoperative Care - methods / Postoperative Complications / Postoperative Complications - prevention & control / Prospective Studies / Pulmonary Disease, Chronic Obstructive / Pulmonary Disease, Chronic Obstructive - surgery / Respiratory failure / Surgery / Thoracic surgery / Time Factors / Ventilators