E. Santos1,2, R. Monteiro2,3, J. Macedo4, W. Poncin4, A. Lunardi1,3
1Universidade Cidade de São Paulo, Master and Doctoral Programs, Sao Paulo, Brazil, 2Universidade Federal do Amapá, Department of Biological and Health Sciences, Macapa, Brazil, 3Universidade de São Paulo, Department of Physical Therapy of School of Medicine, Sao Paulo, Brazil, 4Cliniques Universitaires Saint-Luc, Service de Pneumologie, Brussels, Belgium
Background: Thoracic procedures are used in the diagnostic and management of diseases associated with the lung, pleura, and mediastinum and its viscera. Pulmonary complications still arise from these procedures and are connected with in-hospital mortality. Consequently, prophylactic and post-operative therapeutic strategies have been investigated for managing complications after pulmonary and heart surgeries, including non-invasive ventilation (NIV). However, it is currently not clear whether NIV should or not be proposed to patients undergoing a cardio-pulmonary surgery.
Purpose: To investigate the effects of NIV on patients undergoing invasive thoracic procedures.
Methods: Systematic review with meta-analysis of randomized trials involving the use of NIV compared to usual care after invasive thoracic procedures. CENTRAL, Embase, CINAHL, AMED, PsycINFO, Pubmed, LILACS, SciELO, Scopus, PEDro, and Cochrane Library were screened from May 2015 to September 2020. Eligible articles were screened by two independent researchers. Outcome measures were lung function, oxygenation, length of hospital stays, need for tracheal intubation, postoperative pulmonary complications, mortality and adverse events. The methodological quality of the studies was scored using the PEDro scale. PROSPERO registration no. CRD42015019004.
Results: Twenty-three trials involving a total of 2531 participants were included. The sample was composed by patients undergoing cardiac surgery (12 trials), pulmonary surgery (8 trials), thoracic drainage due to pleural effusion (1 trial) and combined cardio-pulmonary surgery (2 trials). Quality appraisal score on the PEDro scale was low, with a mean score of 5.3 out of 10 points. The meta-analysis indicated that the use of NIV was inferior than the use of oxygen for patients’ oxygenation recovery [Mean difference 0.36 (IC95% 0.15–0.58)] after thoracic procedures. No differences were observed for lung function recovery, length of hospital stay, need of tracheal intubation or mortality. However, the NIV was superior than other intervention to prevent pulmonary complications [Odds ratioDDs 0.37 (95% CI: 0.16 to 0.87)] whereas the number of adverse events did not differ between NIV and other intervention [ODDs 1.48 (IC95% 0.75–2.93)].
Conclusion(s): Compared to other types of interventions, the use of NIV prevents pulmonary complications after invasive thoracic procedures without increasing the rate of adverse events However, this clinical benefit does not appear to be connected with the recovery of oxygenation or pulmonary function. Future studies should investigate the mechanism of action of NIV to prevent pulmonary complications.
Implications: Many health care professionals report fear of using NIV in patients undergoing invasive thoracic procedures due to the risk of adverse effects such as aerophagia and pleural fistula. This systematic review shows that NIV is better than breathing exercises and respirators and bronchial toilets to prevent pulmonary complications without increasing the rate of adverse events. Therefore, according to the scientific evidence available to date, NIV is an efficient and safe technique for patients undergoing invasive thoracic procedures.
Funding, acknowledgements: The present study was funded by the National Council for Scientific and Technological Development (CNPq), project number 442709/2014-5.
Keywords: Non-invasive Positive Pressure, Systematic Review, Thoracic surgery
Topic: Critical care
Did this work require ethics approval? No
Institution: NA
Committee: NA
Reason: This is a systematic review without enrollment of subjects or theirs individual data
All authors, affiliations and abstracts have been published as submitted.
