Chest
Volume 112, Issue 1, July 1997, Pages 117-121
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Clinical Investigations: Surgery: Articles
Noninvasive Ventilatory Support After Lung Resectional Surgery

https://doi.org/10.1378/chest.112.1.117Get rights and content

Study objectives

To investigate the short-term effects of noninvasive ventilatory support (NIVS) on pulmonary gas exchange, ventilatory pattern, systemic hemodynamics, and pleural air leaks in patients submitted to elective lung resection.

Design

Prospective, randomized, parallel, and controlled investigation.

Setting

Thoracic Surgery Unit, Hospital Universitari Son Dureta, Palma Mallorca, Spain.

Patients

Nineteen patients electively submitted to lung resection because of varied clinical reasons.

Interventions

Medical therapy was standardized for all patients. Ten subjects received NIVS with a nasal ventilatory support system (BiPAP) during 1 h (study group). The remaining nine individuals constituted the control group.

Measurements and results

Arterial blood gases, ventilatory pattern, systemic hemodynamics, and pleural air leaks were measured. Before surgery, there were no significant clinical or functional differences between groups. After surgery, and compared with preoperative measures, PaO2 decreased significantly (p<0.01) and to the same extent both in the study group (85.7±2.8 to 68.0±2.7 mm Hg) and the control group (83.6±2.5 to 67.3±2.6 mm Hg). In the study group, NIVS increased PaO2 (to 76.7±3.0 mm Hg; p<0.05) and decreased alveolar to arterial oxygen pressure gradient (P[A-a]O2) (27.2±2.7 to 17.6±2.3 mm Hg; p<0.05). This latter effect was still present 1 h after withdrawing NIVS. By contrast, PaO2 and P(A-a)O2 remained unchanged in the control group throughout the study. PaCO2, the ventilatory pattern, and systemic hemodynamics did not change significantly throughout the study in any group. Importantly, NIVS did not increase dead space to tidal volume ratio or worsen pleural air leaks.

Conclusions

Short-term NIVS with a ventilatory support system improves the efficiency of the lung as a gas exchanger without noticeable nondesired side effects in patients submitted to lung resectional surgery.

Section snippets

Subjects

This investigation was approved by the Ethics Committee of the Hospital Universitari Son Dureta. Written consent was obtained from all participants after they were fully informed of the nature, characteristics, aims, and potential risks of the study. All patients scheduled for elective lung resection in our hospital during the study period were initially considered potential candidates. Patients were excluded if one or more of these conditions occurred: (1) incisions other than posterolateral

Results

Twenty-two patients initially entered the study. However, two patients were excluded before randomization because of hemodynamic instability. Twenty patients were randomized (10 in each group). One of the patients allocated in the study group requested to withdraw from the study because of nasal mask intolerance. The remaining 19 patients completed the study. Indications for surgery in these patients were primary lung cancer (15 patients), single metastasis to the lung (two patients), hamartoma

Discussion

This investigation evaluates the short-term physiologic effects of NIVS with a nasal ventilatory support system (BiPAP) in the immediate postoperative period of patients submitted to lung resectional surgery. Our results show that NIVS improves the efficiency of the lung as a gas exchanger (PaO2 increased and P[A-a]O2 decreased) without causing any deleterious side effect, such as increasing VD/VT, pleural air leakage, or jeopardizing the hemodynamic condition of the patient.

Previous studies

ACKNOWLEDGMENTS

The authors thank M. Llobera, MD, and C. Montero, MD (Thoracic Surgery Unit, Hospital Universitari Son Dureta) for their cooperation during the surgical procedures, and the nursing staff of the Hospital Universitari Son Dureta, particularly M. Bosch and F. Bauzá, for their help during the studies.

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Supported, in part, by Fondo de Investigaciones Sanitarias de la Seguridad Social (FIS 93/0855), ABEMAR, and a research grant from Carburos Metálicos SA.

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