Journal Article

Efficacy of continuous positive airway pressure and incentive spirometry on respiratory functions during the postoperative period following supratentorial craniotomy: A prospective randomized controlled study

Tunali, Yusuf, Vehid, Hayriye, Dilmen, Ozlem Korkmaz, Sah, Hulya Kahraman, Akcil, Eren Fatma

2017

Overview

Volume controlled ventilation with low PEEP is used in neuro-anesthesia to provide constant PaCO2 levels and prevent raised intracranial pressure. Therefore, neurosurgery patients prone to atelectasis formation, however, we could not find any study that evaluates prevention of postoperative pulmonary complications in neurosurgery. A prospective, randomized controlled study. Intensive care unit in a university hospital in Istanbul. Seventy-nine ASAI-II patients aged between 18 and 70years scheduled for elective supratentorial craniotomy were included in the study. Patients randomized into 3 groups after surgery. The Group IS (n=20) was treated with incentive spirometry 5 times in 1min and 5min per hour, the Group CPAP (n=20) with continuous positive airway pressure 10 cmH2O pressure and 0.4 FiO2 via an oronasal mask 5min per hour, and the Group Control (n=20) 4L·min−1O2 via mask; all during the first 6h postoperatively. Respiratory functions tests and arterial blood gases analysis were performed before the induction of anesthesia (Baseline), 30min, 6h, 24h postoperatively. The IS and CPAP applications have similar effects with respect to FVC values. The postoperative 30min FEV1 values were statistically significantly reduced compared to the Baseline in all groups (p<0.0001). FEV1 values were statistically significantly increased at the postoperative 24h compared to the postoperative 30min in the Groups IS and CPAP (p<0.0001). This increase, however, was not observed in the Group Control, and the postoperative 24h FEV1 values were statistically significantly lower in the Group Control compared to the Group IS (p=0.015). Although this study is underpowered to detect differences in FEV1 values, the postoperative 24h FEV1 values were significantly higher in the IS group than the Control group and this difference was not observed between the CPAP and Control groups. It might be evaluate a favorable effect of IS in neurosurgery patients. But larger studies are needed to make a certain conclusion. •Volume controlled MV with low PEEP and without recruitment maneuver in craniotomies often lends itself to atelectasis and V/Q mismatch.•The effects of IS and CPAP on pulmonary function tests as well as ABG’s were compared in patients after supratentorial craniotomy.•The IS and CPAP applications have similar effects with respect to FVC values.•The postoperative 24h FEV1 values were significantly higher in the IS group than the Control group•This difference was not observed between the CPAP and Control groups.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Abdomen / Abdominal surgery / Adult / Anesthesia / Anesthesia, Inhalation - adverse effects / Anesthesia, Inhalation - methods / Anesthetics, Inhalation - adverse effects / Blood Gas Analysis / Continuous positive airway pressure / Continuous Positive Airway Pressure - instrumentation / Continuous Positive Airway Pressure - methods / Coronary vessels / Craniotomy / Craniotomy - adverse effects / Craniotomy - methods / Female / Forced Expiratory Volume / Heart surgery / Humans / Incentive spirometry / Intensive care / Intracranial Hypertension - etiology / Intracranial Hypertension - prevention & control / Intubation / Lung - physiology / Male / Masks / Medical personnel / Methyl Ethers - adverse effects / Middle Aged / Neurosurgery / Pain Medicine / Postoperative Care - methods / Postoperative Complications - etiology / Postoperative Complications - prevention & control / Postoperative period / Postoperative pulmonary complications / Prevention / Prospective Studies / Pulmonary Atelectasis - etiology / Pulmonary Atelectasis - prevention & control / Pulmonary function tests / Respiration / Respiratory Function Tests / Respiratory therapy / Spirometry / Treatment Outcome / Veins & arteries / Ventilators / Young Adult