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Ann Surg. 2008 Apr;247(4):617-26. doi: 10.1097/SLA.0b013e3181675829.

Continuous positive airway pressure for treatment of respiratory complications after abdominal surgery: a systematic review and meta-analysis.

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  • 1Dipartimento di Anestesia e Rianimazione, Azienda Ospedaliera S. Giovanni Battista-Molinette, Universit√† di Torino, Italy.

Abstract

OBJECTIVE:

We evaluated the potential benefit of continuous positive airway pressure (CPAP) to prevent postoperative pulmonary complications (PPCs), atelectasis, pneumonia, and intubation in patients undergoing major abdominal surgery.

SUMMARY BACKGROUND DATA:

PPCs are common during the postoperative period and may be associated with a high morbidity rate. Efficacy of CPAP to prevent PPCs occurrence is controversial.

METHODS:

Medical literature databases were searched for randomized controlled trials examining the use of CPAP versus standard therapy in patients undergoing abdominal surgery. The meta-analysis estimated the pooled risk ratio and the number needed to treat to benefit (NNTB) for PPCs, atelectasis, and pneumonia.

RESULTS:

The meta-analysis was carried out over 9 randomized controlled trials. Overall, CPAP significantly reduced the risk of (1) PPCs (risk ratio, 0.66; 95% confidence interval [CI], 0.52-0.85) with a corresponding NNTB of 14.2 (95% CI, 9.9-32.4); (2) atelectasis (risk ratio, 0.75; 95% CI, 0.58-0.97; NNTB, 7.3; 95% CI, 4.4-64.5); (3) pneumonia (risk ratio, 0.33; 95% CI, 0.14-0.75; NNTB, 18.3; 95% CI, 14.4-48.8). In all cases the variation in risk ratio attributable to heterogeneity was negligible, although there was some evidence of publication bias.

CONCLUSIONS:

This systematic review suggests that CPAP decreases the risk of PPCs, atelectasis, and pneumonia and supports its clinical use in patients undergoing abdominal surgery.

PMID:
18362624
DOI:
10.1097/SLA.0b013e3181675829
[PubMed - indexed for MEDLINE]
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