Prophylactic continuous positive airway pressure after pulmonary lobectomy: A randomized controlled trial

Alessandro Palleschi, Emilia Privitera, Marta Lazzeri, Sara Mariani, Lorenzo Rosso, Davide Tosi, Paolo Mendogni, Ilaria Righi, Rosaria Carrinola, Matteo Montoli, Marco Reda, Massimo Torre, Luigi Santambrogio, Mario Nosotti

Research output: Contribution to journalArticle

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Abstract

Background: Despite advances in perioperative care and surgical techniques, patients undergoing pulmonary lobectomy are still at high risk for postoperative complications. Among interventions expected to reduce complications, continuous positive airway pressure (CPAP) is a discussed option. This trial aims to test the hypothesis whether prophylactic application of CPAP following pulmonary lobectomy can reduce postoperative complications. Methods: The study was designed as a prospective, randomized, controlled trial. Patients with clinical stage I non-small cell lung cancer scheduled for pulmonary lobectomy were eligible and were trained for the use of CPAP interface. The control group received standard postoperative pain management and physiotherapy; in addition, the study group received CPAP (PEEP 8-12 cmH2O, 2 hours thrice daily for three days). Results: After the appropriate selection, 163 patients were considered for the analysis: 82 patients constituted the control group, 81 the study group. The two groups were substantially comparable for preoperative parameters. The rate of postoperative complications was lower in the study group (24.7% vs. 43.9%; P=0.015) as well as the hospital stay (6 vs. 7 days; P=0.031). The stepwise logistic regression model identified: CPAP [odd ratio (OR): 0.3026, CI: 0.1389-0.6591], smoke habits [OR: 2.5835, confidence interval (CI): 1.0331-6.4610] and length of surgery in minutes (OR: 1.0102, CI: 1.0042-1.0163) as regressors on postoperative complications. Conclusions: The present trial demonstrated that prophylactic application of CPAP during the postoperative period after pulmonary lobectomy for stage I non-small cell lung cancer was effective in prevent postoperative complications.

Original languageEnglish
Pages (from-to)2829-2836
Number of pages8
JournalJournal of Thoracic Disease
Volume10
Issue number5
DOIs
Publication statusPublished - May 1 2018

Fingerprint

Continuous Positive Airway Pressure
Randomized Controlled Trials
Lung
Odds Ratio
Confidence Intervals
Non-Small Cell Lung Carcinoma
Logistic Models
Perioperative Care
Control Groups
Pain Management
Postoperative Pain
Postoperative Period
Smoke
Patient Selection
Habits
Length of Stay

Keywords

  • Continuous positive airway pressure (CPAP)
  • Lung neoplasms
  • Postoperative complications
  • Thoracic surgery

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Prophylactic continuous positive airway pressure after pulmonary lobectomy : A randomized controlled trial. / Palleschi, Alessandro; Privitera, Emilia; Lazzeri, Marta; Mariani, Sara; Rosso, Lorenzo; Tosi, Davide; Mendogni, Paolo; Righi, Ilaria; Carrinola, Rosaria; Montoli, Matteo; Reda, Marco; Torre, Massimo; Santambrogio, Luigi; Nosotti, Mario.

In: Journal of Thoracic Disease, Vol. 10, No. 5, 01.05.2018, p. 2829-2836.

Research output: Contribution to journalArticle

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abstract = "Background: Despite advances in perioperative care and surgical techniques, patients undergoing pulmonary lobectomy are still at high risk for postoperative complications. Among interventions expected to reduce complications, continuous positive airway pressure (CPAP) is a discussed option. This trial aims to test the hypothesis whether prophylactic application of CPAP following pulmonary lobectomy can reduce postoperative complications. Methods: The study was designed as a prospective, randomized, controlled trial. Patients with clinical stage I non-small cell lung cancer scheduled for pulmonary lobectomy were eligible and were trained for the use of CPAP interface. The control group received standard postoperative pain management and physiotherapy; in addition, the study group received CPAP (PEEP 8-12 cmH2O, 2 hours thrice daily for three days). Results: After the appropriate selection, 163 patients were considered for the analysis: 82 patients constituted the control group, 81 the study group. The two groups were substantially comparable for preoperative parameters. The rate of postoperative complications was lower in the study group (24.7{\%} vs. 43.9{\%}; P=0.015) as well as the hospital stay (6 vs. 7 days; P=0.031). The stepwise logistic regression model identified: CPAP [odd ratio (OR): 0.3026, CI: 0.1389-0.6591], smoke habits [OR: 2.5835, confidence interval (CI): 1.0331-6.4610] and length of surgery in minutes (OR: 1.0102, CI: 1.0042-1.0163) as regressors on postoperative complications. Conclusions: The present trial demonstrated that prophylactic application of CPAP during the postoperative period after pulmonary lobectomy for stage I non-small cell lung cancer was effective in prevent postoperative complications.",
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T1 - Prophylactic continuous positive airway pressure after pulmonary lobectomy

T2 - A randomized controlled trial

AU - Palleschi, Alessandro

AU - Privitera, Emilia

AU - Lazzeri, Marta

AU - Mariani, Sara

AU - Rosso, Lorenzo

AU - Tosi, Davide

AU - Mendogni, Paolo

AU - Righi, Ilaria

AU - Carrinola, Rosaria

AU - Montoli, Matteo

AU - Reda, Marco

AU - Torre, Massimo

AU - Santambrogio, Luigi

AU - Nosotti, Mario

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background: Despite advances in perioperative care and surgical techniques, patients undergoing pulmonary lobectomy are still at high risk for postoperative complications. Among interventions expected to reduce complications, continuous positive airway pressure (CPAP) is a discussed option. This trial aims to test the hypothesis whether prophylactic application of CPAP following pulmonary lobectomy can reduce postoperative complications. Methods: The study was designed as a prospective, randomized, controlled trial. Patients with clinical stage I non-small cell lung cancer scheduled for pulmonary lobectomy were eligible and were trained for the use of CPAP interface. The control group received standard postoperative pain management and physiotherapy; in addition, the study group received CPAP (PEEP 8-12 cmH2O, 2 hours thrice daily for three days). Results: After the appropriate selection, 163 patients were considered for the analysis: 82 patients constituted the control group, 81 the study group. The two groups were substantially comparable for preoperative parameters. The rate of postoperative complications was lower in the study group (24.7% vs. 43.9%; P=0.015) as well as the hospital stay (6 vs. 7 days; P=0.031). The stepwise logistic regression model identified: CPAP [odd ratio (OR): 0.3026, CI: 0.1389-0.6591], smoke habits [OR: 2.5835, confidence interval (CI): 1.0331-6.4610] and length of surgery in minutes (OR: 1.0102, CI: 1.0042-1.0163) as regressors on postoperative complications. Conclusions: The present trial demonstrated that prophylactic application of CPAP during the postoperative period after pulmonary lobectomy for stage I non-small cell lung cancer was effective in prevent postoperative complications.

AB - Background: Despite advances in perioperative care and surgical techniques, patients undergoing pulmonary lobectomy are still at high risk for postoperative complications. Among interventions expected to reduce complications, continuous positive airway pressure (CPAP) is a discussed option. This trial aims to test the hypothesis whether prophylactic application of CPAP following pulmonary lobectomy can reduce postoperative complications. Methods: The study was designed as a prospective, randomized, controlled trial. Patients with clinical stage I non-small cell lung cancer scheduled for pulmonary lobectomy were eligible and were trained for the use of CPAP interface. The control group received standard postoperative pain management and physiotherapy; in addition, the study group received CPAP (PEEP 8-12 cmH2O, 2 hours thrice daily for three days). Results: After the appropriate selection, 163 patients were considered for the analysis: 82 patients constituted the control group, 81 the study group. The two groups were substantially comparable for preoperative parameters. The rate of postoperative complications was lower in the study group (24.7% vs. 43.9%; P=0.015) as well as the hospital stay (6 vs. 7 days; P=0.031). The stepwise logistic regression model identified: CPAP [odd ratio (OR): 0.3026, CI: 0.1389-0.6591], smoke habits [OR: 2.5835, confidence interval (CI): 1.0331-6.4610] and length of surgery in minutes (OR: 1.0102, CI: 1.0042-1.0163) as regressors on postoperative complications. Conclusions: The present trial demonstrated that prophylactic application of CPAP during the postoperative period after pulmonary lobectomy for stage I non-small cell lung cancer was effective in prevent postoperative complications.

KW - Continuous positive airway pressure (CPAP)

KW - Lung neoplasms

KW - Postoperative complications

KW - Thoracic surgery

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