Thu Nguyen Dang, Thuy Nguyen Thi, Nguyen Le Sau, Thang Cong Quyet, Thach Nguyen Ngoc, Kien Nguyen Trung
Vietnam Military Medical University, Military Hospital 103, Department of Anesthesiology, Hanoi, Vietnam.
Friendship Hospital, Department of Anesthesiology, Hanoi, Vietnam.
Braz J Anesthesiol. 2025 May 17;75(5):844642. doi: 10.1016/j.bjane.2025.844642.
Geriatric patients undergoing major open abdominal surgery are at high risk for postoperative pulmonary complications and hypoxemia. Continuous Positive Airway Pressure (CPAP) after surgery may improve postoperative lung function. This randomized controlled trial compared two CPAP techniques ‒ automatic via nasal mask and constant via facial mask ‒ regarding pulmonary function and patient tolerance.
Sixty patients (≥ 60 years) were randomized (1:1) to receive either automatic CPAP (2-10 cm HO) via a nasal mask (Group A) or constant CPAP (7.5 cm HO) via a facial mask (Group C) upon arrival in the post-anesthesia care unit. Oxygenation (PaO, PaO₂/FiO₂, SpO) and spirometry (FVC, FEV, PEF) were assessed preoperatively, postoperatively, and one hour after treatment. Comfort scores (0-10, with 0 indicating the best comfort) and complications were recorded.
PaO₂/FiO improvement was lower in Group A (32.6 ± 26.3 mmHg) than in Group C (52.9 ± 40.1 mmHg; p = 0.023). FVC improvement was also lower in Group A (3.7% ± 4.0%) than in Group C (6.7% ± 4.9%; p = 0.012). However, Group A had better tolerance, with lower comfort scores (2 [2-3] vs. 3 [2-4], p = 0.002). Pulmonary function benefits were more pronounced in patients over 70 and those undergoing upper abdominal surgery.
Both CPAP techniques prevent pulmonary decline in geriatric patients post-surgery. While automatic CPAP provides better comfort, constant CPAP improves oxygenation. Although our findings are short-term, they suggest that CPAP mode selection should be tailored based on patient-specific needs.
接受大型开放性腹部手术的老年患者术后发生肺部并发症和低氧血症的风险很高。术后持续气道正压通气（CPAP）可能会改善术后肺功能。这项随机对照试验比较了两种CPAP技术——经鼻面罩自动通气和经面部面罩持续通气——在肺功能和患者耐受性方面的差异。
60名年龄≥60岁的患者被随机分为两组（1:1），在进入麻醉后护理单元时，一组通过鼻面罩接受自动CPAP（2-10 cm H₂O）（A组），另一组通过面部面罩接受持续CPAP（7.5 cm H₂O）（C组）。在术前、术后和治疗后1小时评估氧合情况（PaO₂、PaO₂/FiO₂、SpO₂）和肺量测定（FVC、FEV₁、PEF）。记录舒适度评分（0-10分，0分表示最佳舒适度）和并发症情况。
A组的PaO₂/FiO₂改善幅度（32.6±26.3 mmHg）低于C组（52.9±40.1 mmHg；p = 0.023）。A组的FVC改善幅度（3.7%±4.0%）也低于C组（6.7%±4.9%；p = 0.012）。然而，A组的耐受性更好，舒适度评分更低（2[2-3] vs. 3[2-4]，p = 0.002）。70岁以上患者和接受上腹部手术的患者肺功能获益更为明显。
两种CPAP技术均可预防老年患者术后肺功能下降。自动CPAP提供更好的舒适度，而持续CPAP改善氧合。尽管我们的研究结果是短期的，但它们表明应根据患者的具体需求来选择CPAP模式。
