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Annals of Surgery:
doi: 10.1097/SLA.0b013e3181675829

Continuous Positive Airway Pressure for Treatment of Respiratory Complications After Abdominal Surgery: A Systematic Review and Meta-Analysis

Ferreyra, Gabriela P. RT*; Baussano, Iacopo MD, PhD†‡; Squadrone, Vincenzo MD*; Richiardi, Lorenzo MD, PhD§; Marchiaro, Giovana MD*; Del Sorbo, Lorenzo MD*; Mascia, Luciana MD, PhD*; Merletti, Franco MD, PhD§; Ranieri, V Marco MD*

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Objective: We evaluated the potential benefit of continuous positive airway pressure (CPAP) to prevent postoperative pulmonary complications (PPCs), atelectasis, pneumonia, and intubation in patients undergoing major abdominal surgery.

Summary Background Data: PPCs are common during the postoperative period and may be associated with a high morbidity rate. Efficacy of CPAP to prevent PPCs occurrence is controversial.

Methods: Medical literature databases were searched for randomized controlled trials examining the use of CPAP versus standard therapy in patients undergoing abdominal surgery. The meta-analysis estimated the pooled risk ratio and the number needed to treat to benefit (NNTB) for PPCs, atelectasis, and pneumonia.

Results: The meta-analysis was carried out over 9 randomized controlled trials. Overall, CPAP significantly reduced the risk of (1) PPCs (risk ratio, 0.66; 95% confidence interval [CI], 0.52–0.85) with a corresponding NNTB of 14.2 (95% CI, 9.9–32.4); (2) atelectasis (risk ratio, 0.75; 95% CI, 0.58–0.97; NNTB, 7.3; 95% CI, 4.4–64.5); (3) pneumonia (risk ratio, 0.33; 95% CI, 0.14–0.75; NNTB, 18.3; 95% CI, 14.4–48.8). In all cases the variation in risk ratio attributable to heterogeneity was negligible, although there was some evidence of publication bias.

Conclusions: This systematic review suggests that CPAP decreases the risk of PPCs, atelectasis, and pneumonia and supports its clinical use in patients undergoing abdominal surgery.

© 2008 Lippincott Williams & Wilkins, Inc.