Lung

, Volume 194, Issue 2, pp 201–217 | Cite as

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
Article

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, τ 2 = 0.078, r 2 = 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.

Keywords

Prophylactic CPAP Postoperative pulmonary complication Atelectasis Pneumonia 

Notes

Compliance with Ethical Standards

Conflict of interest

None.

Supplementary material

408_2016_9855_MOESM1_ESM.enq (1 kb)
Supplementary material 1 (ENQ 604 bytes)
408_2016_9855_MOESM2_ESM.docx (13 kb)
Table showing PaO2/FiO2 ratios in preoperative and postoperative phase. Supplementary material 2 (DOCX 12 kb)

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Preet Mohinder Singh
    • 1
  • Anuradha Borle
    • 1
  • Dipal Shah
    • 1
    • 5
  • Ashish Sinha
    • 2
  • Jeetinder Kaur Makkar
    • 3
  • Anjan Trikha
    • 1
  • Basavana Gouda Goudra
    • 4
  1. 1.Department of AnesthesiaAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Anesthesiology and Perioperative MedicineDrexel University College of MedicinePhiladelphiaUSA
  3. 3.Post Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  4. 4.Department of AnesthesiaHospital of the University of PennsylvaniaPhiladelphiaUSA
  5. 5.Rhushabh Nursing HomeMumbaiIndia

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