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Titre : | Non-Invasive Positive airway Pressure thErapy to Reduce Postoperative Lung complications following Upper abdominal Surgery (NIPPER PLUS): a pilot randomised control trial (2022) |
Auteurs : | Jane Lockstone ; S.M. Parry ; L. Denehy ; Iain Kilpatrick Robertson ; D. Story ; I. Boden |
Type de document : | Article |
Dans : | Physiotherapy (Vol. 117, 2022) |
Article en page(s) : | p. 25-34 |
Note générale : | https://doi.org/10.1016/j.physio.2022.06.001 |
Langues: | Français |
Descripteurs : |
HE Vinci Abdomen ; Chirurgie générale ; Complications postopératoires ; Soins postopératoires ; Ventilation non effractive |
Résumé : | Objectives Postoperative pulmonary complications (PPCs) are a common serious complication following upper abdominal surgery. Postoperatively, physiotherapy-led non-invasive ventilation (NIV) may be a promising method to reduce PPC incidence. The objectives of this pilot trial were to examine preliminary effectiveness, feasibility and safety of additional intermittent physiotherapy-led NIV compared to continuous high-flow nasal cannula oxygen therapy (HFNC) alone. Design Single-centre, assessor-blinded, parallel-group, pilot randomised control trial. Setting Primary-referral hospital in Australia. Participants 130 high-risk patients undergoing upper abdominal surgery. Interventions Continuous HFNC for 48-hours following surgical extubation, or HFNC plus five 30-minute physiotherapy-led NIV sessions. Outcomes PPC incidence, trial feasibility and safety. Results PPC incidence was similar between groups (HFNC alone 12/65 (18%) vs HFNC plus NIV 10/64 (16%) adjusted HR 0.95; 95% CI 0.40?2.29). Delivery of HFNC as per-protocol was achieved in 81% (n?=?105) of all participants. Physiotherapy-led NIV initiated within four-hours of surgical extubation was achieved in 81% (n?=?52) of intervention group participants, with a mean 4.2 (SD 1.3) total number of NIV sessions delivered in the first two postoperative days. NIV was delivered as per-protocol in 52% of this cohort. Two episodes of severe hypotension during NIV requiring medical intervention were reported. Conclusion Delivery of continuous HFNC was feasible. Delivery of NIV within four-hours of extubation was achieved and delivered safely with1% adverse events. The planned NIV intervention of five sessions within two postoperative days was not feasible. The results of this pilot study have informed the decision not to proceed to a fully powered trial. Clinical Trial Registration Australian New Zealand Clinical Trials Registry, www.anzctr.org.au ACTRN12617000269336. Contribution of the Paper ?A protocol of continuous postoperative HFNC is feasible, well-tolerated and acceptable to high-risk adults following elective upper abdominal surgery.?Prophylactic physiotherapy-led NIV within the early postoperative period is feasible in some cases. Physiotherapy-led NIV can be delivered safely to high-risk adults following elective upper abdominal surgery in the post-anaesthetic care unit, ICU and surgical ward setting.?Delivery of a physiotherapy-led NIV protocol of five sessions over two postoperative days is not feasible to warrant progression to a future definitive trial. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0031940622000694 |