Prophylactic use of noninvasive ventilation in patients undergoing lung resectional surgery

SummaryQuestion of the studyWe studied whether prophylactic use of noninvasive pressure support ventilation (NIPSV) administered pre- and postoperatively may reduce the postoperative pulmonary function impairment.Patients and methodsProspective randomized clinical trial. Thirty-nine patients with a preoperative FEV1<70% of the predicted value scheduled for elective lobectomy related to lung cancer were enrolled. Seven patients were excluded after enrollment. Patients were required to follow standard treatment without (control group, n=18) or with NIPSV (study group, n=14) during 7 days at home before surgery, and during 3 days postoperatively. Primary outcome variable was the changes on arterial blood gases on room air.ResultsTwo hours after surgery, PaO2, FVC and FEV1 values were significantly better in the NIPSV group. On day 1, 2 and 3, PaO2 was significantly improved in the NIPSV group. Also on day 1, FVC and FEV1 improved significantly in the NIPSV group. The hospital stay was significantly longer in the control group than in the study group (p=0.04). The incidence of major atelectasis was 14.2% in the NIPSV group and 38.9% in the no-NIPSV group (p=0.15).Answer to the questionProphylactic use of NIPSV in a pre- and postoperative manner significantly reduces pulmonary dysfunction after lung resection. As a result, recovery of preoperative respiratory function is accelerated.