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Non-Invasive Respiratory Support for Management of the Perioperative Patient: A Narrative Review

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Abstract

Background

Non-invasive respiratory support including high-flow nasal oxygen (HFNO), continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) is routinely used in the perioperative period.

Objectives

The aim of this narrative review was to discuss some of the existing literature on perioperative non-invasive respiratory support outlining its potential roles in each of the three perioperative periods (pre-, intra- and postoperatively) and to propose the way forward.

Results

During induction of anesthesia, non-invasive ventilation (NIV) was associated with improved ventilatory variables and reduced risk of postoperative respiratory complications. HFNO did not seem to confer an advantage in terms of peri-intubation hypoxemia. Intraoperative data on NIV are scarce. Upper airway obstruction and worsening hypoventilation are two risks associated with its use. Compared with conventional oxygenation, HFNO is associated with a reduced risk of hypoxemia. Postoperative NIV has been associated with improved arterial blood gases and a reduced reintubation rate, but no difference was reported for mortality, hospital length of stay, rate of anastomotic leakage, pneumonia-related complications and sepsis or infections. Head-to-head comparison of HFNO versus BiPAP showed no advantage to either mode of support.

Conclusion

In the preoperative setting, NIV seems to be associated with improved clinical outcomes in specific patient subgroups (obesity, pregnancy). In the postoperative setting, both NIV and HFNO were associated with lower reintubation rates. The literature has provided little evidence regarding the use of non-invasive ventilatory support in other patient subgroups or intraoperatively. There is also little literature regarding the appropriateness of combining different modes of support. In the next years, the combination of several modes of respiratory support should be assessed in targeted populations.

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Acknowledgements

Funding

No funding or sponsorship was received for the publication of this article.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosures

Sharon Einavand Ines Lakbar have nothing to disclose. Marc Leone served as lecturer for MSD, Aspen and consultant for Gilead, Amomed.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

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Authors and Affiliations

  1. Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel

    Sharon Einav

  2. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Sharon Einav

  3. Department of Anesthesiology and Intensive Care Unit, Toulouse, France

    Ines Lakbar

  4. Intensive Care Unit, Department of Anesthesiology, Aix Marseille Université, Hôpitaux Universitaires de Marseille, Hôpital Nord, Marseille, France

    Marc Leone

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  1. Sharon Einav
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Correspondence to Marc Leone.

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Einav, S., Lakbar, I. & Leone, M. Non-Invasive Respiratory Support for Management of the Perioperative Patient: A Narrative Review. Adv Ther 38, 1746–1756 (2021). https://doi.org/10.1007/s12325-021-01668-z

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