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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*

doi: 10.1097/SLA.0b013e3181675829

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.

This meta-analysis analyzes early application of continuous positive airway pressure in postoperative abdominal surgery. Nine randomized control trials published between 1979 and 2005 were included. Continuous positive airway pressure was associated with reduced incidence of pulmonary complications.

From the *Dipartimento di Anestesia e Rianimazione, Azienda Ospedaliera S. Giovanni Battista-Molinette, Università di Torino, Italy; †SCDU Epidemiologia dei Tumori, CPO-Piemonte, Novara; ‡Division of Epidemiology, Public Health and Primary Care, Faculty of Medicine, Imperial College London; and §Cancer Epidemiology Unit, CPO Piemonte, CeRMS, Università di Torino, Italy.

Supported by Regione Piemonte: Ricerca Sanitaria Finalizzata (Grant 3ACS-03) and Università di Torino: Progetti di Ricerca Locali (grant PR60ANRA03).

The first two authors contributed equally to the work and should be considered first author.

Reprints: V. Marco Ranieri, MD, Dipartimento di Anestesiologia e Rianimazione, Università di Torino, Ospedale S. Giovanni Battista-Molinette, Corso Dogliotti 14, 10126 Torino, Italy. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.