TY - JOUR
T1 - Optimizing Prophylactic CPAP in Patients Without Obstructive Sleep Apnoea for High-Risk Abdominal Surgeries
T2 - A Meta-regression Analysis
AU - Singh, Preet Mohinder
AU - Borle, Anuradha
AU - Shah, Dipal
AU - Sinha, Ashish
AU - Makkar, Jeetinder Kaur
AU - Trikha, Anjan
AU - Goudra, Basavana Gouda
PY - 2016/4/1
Y1 - 2016/4/1
N2 - 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.
AB - 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.
KW - Atelectasis
KW - Pneumonia
KW - Postoperative pulmonary complication
KW - Prophylactic CPAP
UR - http://www.scopus.com/inward/record.url?scp=84961257008&partnerID=8YFLogxK
U2 - 10.1007/s00408-016-9855-6
DO - 10.1007/s00408-016-9855-6
M3 - Article
C2 - 26896040
AN - SCOPUS:84961257008
SN - 0341-2040
VL - 194
SP - 201
EP - 217
JO - Lung
JF - Lung
IS - 2
ER -