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

Abstract

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.

Trial registration: LIPPSMAck POP (Lung Infection Prevention Post Surgery - Major Abdominal - with Pre Operative Physiotherapy) ANZCTR-12613000664741 (for pre cohort group only).

Keywords: General surgery; Non-invasive ventilation; Postoperative care; Postoperative complications.