Department of Anaesthesia and Postoperative Care, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo 56, Madrid 28007, Spain.
Br J Anaesth. 2014 May;112(5):929-35. doi: 10.1093/bja/aet477. Epub 2014 Feb 3.
Postoperative continuous positive airway pressure (CPAP) can improve lung function. The aim of our study was to assess the efficacy of prophylactic CPAP on the Pa(O2)/FI(O2) ratio measured the day after surgery in patients undergoing lung resection surgery (LRS).
The study population comprised 110 patients undergoing LRS. On arrival in the postanaesthesia care unit (PACU), patients were randomized to receive CPAP at 5-7 cm H2O during the first 6 h after surgery (CPAP group) or supplemental oxygen through a Venturi mask (Venturi group). The Pa(O2)/FI(O2) ratio was measured on arrival in the PACU, 7 h after admission, and the day after surgery. The Pa(O2)/FI(O2) ratio is the primary endpoint of our study. We also analysed the chest radiograph and assessed the postoperative course. We then analysed the impact of ventilatory management in the PACU depending on the respiratory risk of the patient.
Baseline characteristics were similar in both groups. Patients who received CPAP had significantly higher Pa(O2)/FI(O2) at 24 h after surgery compared with patients managed conventionally (Venturi group) (48.6±14 vs 42.3±12, P=0.031), but there were no differences at 7 h. On subgroup analysis, we found that the benefits of CPAP were greater in higher risk patients. The incidence of postoperative pulmonary complications and stay in the PACU and hospital were similar in both groups.
In patients undergoing LRS, prophylactic CPAP during the first 6 h after surgery with a pressure of 5-7 cm H2O improved the Pa(O2)/FI(O2) ratio at 24 h. This effect was more evident in patients with increased risk of postoperative pulmonary complications.
术后持续气道正压通气（CPAP）可改善肺功能。本研究旨在评估预防性 CPAP 对肺切除术（LRS）患者术后第 1 天测量的 Pa（O2）/FI（O2）比值的疗效。
研究人群包括 110 例行 LRS 的患者。患者到达麻醉后恢复室（PACU）后，随机接受术后前 6 小时内 5-7cmH2O 的 CPAP（CPAP 组）或文丘里面罩补充氧气（文丘里组）。PACU 到达时、入院后 7 小时和术后第 1 天测量 Pa（O2）/FI（O2）比值。Pa（O2）/FI（O2）比值是本研究的主要终点。我们还分析了术后胸部 X 线片和评估了术后过程。然后，我们根据患者的呼吸风险分析了 PACU 中的通气管理的影响。
两组患者的基线特征相似。与常规治疗（文丘里组）相比，接受 CPAP 的患者术后第 24 小时的 Pa（O2）/FI（O2）显著更高（48.6±14 比 42.3±12，P=0.031），但在第 7 小时无差异。亚组分析发现，CPAP 的益处在高危患者中更大。两组患者的术后肺部并发症发生率、PACU 和住院时间相似。
在接受 LRS 的患者中，术后前 6 小时内以 5-7cmH2O 的压力使用预防性 CPAP 可改善术后第 24 小时的 Pa（O2）/FI（O2）比值。这种作用在术后肺部并发症风险增加的患者中更为明显。
