Optimizing Prophylactic CPAP in Patients Without Obstructive Sleep Apnoea for High-Risk Abdominal Surgeries: A Meta-regression Analysis

Preet Mohinder Singh, Anuradha Borle, Dipal Shah, Ashish Sinha, Jeetinder Kaur Makkar, Anjan Trikha, Basavana Gouda Goudra

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Introduction: Prophylactic continuous positive airway pressure (CPAP) can prevent pulmonary adverse events following upper abdominal surgeries. The present meta-regression evaluates and quantifies the effect of degree/duration of (CPAP) on the incidence of postoperative pulmonary events. Methods: Medical databases were searched for randomized controlled trials involving adult patients, comparing the outcome in those receiving prophylactic postoperative CPAP versus no CPAP, undergoing high-risk abdominal surgeries. Our meta-analysis evaluated the relationship between the postoperative pulmonary complications and the use of CPAP. Furthermore, meta-regression was used to quantify the effect of cumulative duration and degree of CPAP on the measured outcomes. Results: Seventy-three potentially relevant studies were identified, of which 11 had appropriate data, allowing us to compare a total of 362 and 363 patients in CPAP and control groups, respectively. Qualitatively, Odds ratio for CPAP showed protective effect for pneumonia [0.39 (0.19–0.78)], atelectasis [0.51 (0.32–0.80)] and pulmonary complications [0.37 (0.24–0.56)] with zero heterogeneity. For prevention of pulmonary complications, odds ratio was better for continuous than intermittent CPAP. Meta-regression demonstrated a positive correlation between the degree of CPAP and the incidence of pneumonia with a regression coefficient of +0.61 (95 % CI 0.02–1.21, P = 0.048, τ2 = 0.078, r2 = 7.87 %). Overall, adverse effects were similar with or without the use of CPAP. Conclusions: Prophylactic postoperative use of continuous CPAP significantly reduces the incidence of postoperative pneumonia, atelectasis and pulmonary complications in patients undergoing high-risk abdominal surgeries. Quantitatively, increasing the CPAP levels does not necessarily enhance the protective effect against pneumonia. Instead, protective effect diminishes with increasing degree of CPAP.

Original languageEnglish
Pages (from-to)201-217
Number of pages17
JournalLung
Volume194
Issue number2
DOIs
StatePublished - Apr 1 2016

Keywords

  • Atelectasis
  • Pneumonia
  • Postoperative pulmonary complication
  • Prophylactic CPAP

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