Outcomes of patients with acute respiratory failure after abdominal surgery treated with noninvasive positive pressure ventilation

• Published in: Chest Vol. 128; no. 4; p. 2688
• Main Authors: Jaber, Samir, Delay, Jean-Marc, Chanques, Gérald, Sebbane, Mustapha, Jacquet, Eric, Souche, Bruno, Perrigault, Pierre-François, Eledjam, Jean-Jacques
• Format: Journal Article
• Language: English
• Published: United States 01-10-2005
• Subjects: Abdomen - surgery; Acute Disease; Digestive System Surgical Procedures - methods; Female; Humans; Intubation; Male; Middle Aged; Neoplasms - complications; Positive-Pressure Respiration - methods; Postoperative Complications - therapy; Prospective Studies; Pulmonary Disease, Chronic Obstructive - complications; Respiratory Insufficiency - therapy; Treatment Outcome
• ISSN: 0012-3692
• DOI: 10.1378/chest.128.4.2688

Little is known about the physiologic and clinical effects of noninvasive positive pressure ventilation (NPPV) in patients who have acute respiratory failure (ARF) after abdominal surgery. We evaluated our clinical experience with the use of NPPV in the treatment of ARF after abdominal surgery.
We prospectively evaluated NPPV use during a 2-year period in a medical-surgical ICU of a university hospital. We documented demographic and diagnostic data, gas exchange, and clinical outcomes. We compared patients who were not intubated to those who were intubated after a trial of NPPV.
Of 72 patients with ARF after abdominal surgery who were treated with NPPV, 48 patients avoided intubation (67%). Patients in the intubated and nonintubated groups had similar demographic characteristics, and similar American Society of Anesthesiologists physical status and simplified acute physiology score II scores at admission. The intubated group had a significantly lower Pa(O2)/fraction of inspired oxygen (Fi(O2)) ratio (123 +/- 62 mm Hg vs 194 +/- 76 mm Hg, p < 0.01) and more extended bilateral alveolar infiltrates (67% vs 31%, p < 0.01) than the non-intubated group. Within the first NPPV observation period, the Pa(O2)/Fi(O2) increased (+ 36 +/- 29% [+/- SD], p = 0.04) and the respiratory rate decreased (28.2 +/- 3.4 breaths/min vs 23.1 +/- 3.8 breaths/min, p < 0.01) significantly only in the non-intubated group. The non-intubated group had significantly lower length of ICU stay (17.3 +/- 10.9 days vs 34.1 +/- 28.5 days, p < 0.01) and mortality rate (6% vs 29%, p < 0.01).
NPPV may be an alternative to conventional ventilation in selected patients with ARF after abdominal surgery who require ventilatory support.