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

STUDY OBJECTIVE

Volume controlled ventilation with low PEEP is used in neuro-anesthesia to provide constant PaCO 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.

DESIGN

A prospective, randomized controlled study.

SETTING

Intensive care unit in a university hospital in Istanbul.

PATIENTS

Seventy-nine ASAI-II patients aged between 18 and 70years scheduled for elective supratentorial craniotomy were included in the study.

INTERVENTIONS

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 cmHO pressure and 0.4 FO via an oronasal mask 5min per hour, and the Group Control (n=20) 4L·minO 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.

MAIN RESULTS

The IS and CPAP applications have similar effects with respect to FVC values. The postoperative 30min FEV values were statistically significantly reduced compared to the Baseline in all groups (p<0.0001). FEV 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 FEV values were statistically significantly lower in the Group Control compared to the Group IS (p=0.015).

CONCLUSION

Although this study is underpowered to detect differences in FEV values, the postoperative 24h FEV 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.