Lockstone, J and Parry, SM and Denehy, L and Robertson, IK and Story, D and Parkes, S and Boden, I, Physiotherapist administered, non-invasive ventilation to reduce postoperative pulmonary complications in high-risk patients following elective upper abdominal surgery; a before-and-after cohort implementation study, Physiotherapy ISSN 0031-9406 (2018) [Refereed Article]
© 2018 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
Objectives: To (1) determine whether short, 30-minute sessions of non-invasive ventilation (NIV) is associated with fewer postoperative pulmonary complications (PPC) following elective high-risk upper abdominal surgery and (2) measure feasibility and safety of this intervention when delivered by physiotherapists.
Design: Prospective, pre post cohort, observational, single-centre study.
Setting: Primary referral hospital in Australia.
Participants: A total of 182 consecutive high-risk elective upper abdominal surgery patients consisting of 101 pre cohort participants compared to 81 post cohort participants.
Interventions: Both groups received standardised preoperative physiotherapy and early postoperative mobilisation. The post cohort group received five additional 30-minute NIV sessions in the first two postoperative days.
Main outcome measure: Primary outcome measure was PPC incidence within the first seven postoperative days. Secondary outcomes included feasibility and safety of physiotherapy-led NIV.
Results: Incidence of PPC (7% vs 18%, adjusted relative risk 0.24; 95% CI 0.10 to 0.59, p = 0.002) was less in the NIV group compared to those who received no NIV. Mean time to first NIV session was 18.6 (SD 11.0) hours with 74% of participants receiving NIV within 24-hours of surgery. There were no major adverse events.
Conclusion: These findings suggest PPC reduction may be possible with postoperative NIV following high-risk elective upper abdominal surgery. Results should be seen as hypothesis-generating associations only considering the significant limitations to this study. Physiotherapy-led NIV was delivered safely to ICU and ward patients. However, the planned protocol was not feasible and appropriate physiotherapy staffing and/or a multidisciplinary approach may be required to provide this service successfully.
|Item Type:||Refereed Article|
|Keywords:||general surgery, non-invasive ventilation, postoperative care, postoperative complications|
|Research Division:||Health Sciences|
|Research Group:||Public health|
|Research Field:||Preventative health care|
|Objective Division:||Expanding Knowledge|
|Objective Group:||Expanding knowledge|
|Objective Field:||Expanding knowledge in the health sciences|
|UTAS Author:||Robertson, IK (Dr Iain Robertson)|
|Web of Science® Times Cited:||3|
|Deposited By:||Health Sciences|
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