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Non-invasive positive airway pressure thErapy to reduce postoperative lung complications following upper abdominal surgery (NIPPER PLUS): a pilot randomised control trial

Citation

Lockstone, J and Parry, SM and Denehy, L and Robertson, IK and Story, D and Boden, I, Non-invasive positive airway pressure thErapy to reduce postoperative lung complications following upper abdominal surgery (NIPPER PLUS): a pilot randomised control trial, Physiotherapy pp. 1-24. ISSN 1873-1465 (2022) [Refereed Article]


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DOI: doi:10.1016/j.physio.2022.06.001

Abstract

Objectives:Postoperative pulmonary complications (PPC) 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.

OutcomesPPC 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 with <1% 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.

Item Details

Item Type:Refereed Article
Keywords:abdominal surgery. noninvasive ventilation, postoperative care, postoperative complications, physiotherapy
Research Division:Health Sciences
Research Group:Allied health and rehabilitation science
Research Field:Physiotherapy
Objective Division:Health
Objective Group:Clinical health
Objective Field:Prevention of human diseases and conditions
UTAS Author:Robertson, IK (Dr Iain Robertson)
UTAS Author:Boden, I (Dr Ianthe Boden)
ID Code:151842
Year Published:2022
Deposited By:Health Sciences
Deposited On:2022-08-05
Last Modified:2022-09-01
Downloads:0

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