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Randomized Controlled Trial
. 2014;132(1):41-7.
doi: 10.1590/1516-3180.2014.1321525.

Continuous positive airway pressure (CPAP) after lung resection: a randomized clinical trial

Lígia dos Santos Roceto  1 , Fernanda Diório Masi Galhardo  2 , Ivete Alonso Bredda Saad  3 , Ivan Felizardo Contrera Toro  4
Affiliations
Randomized Controlled Trial

Continuous positive airway pressure (CPAP) after lung resection: a randomized clinical trial

Lígia dos Santos Roceto et al. Sao Paulo Med J. 2014.

Abstract
in English, Portuguese

Context and objective: Noninvasive mechanical ventilation during the postoperative period (PO) following lung resection can restore residual functional capacity, improve oxygenation and spare the inspiratory muscles. The objective of this study was to assess the efficacy of continuous positive airway pressure (CPAP) associated with physiotherapy, compared with physiotherapy alone after lung resection.

Design and setting: Open randomized clinical trial conducted in the clinical hospital of Universidade Estadual de Campinas.

Method: Sessions were held in the immediate postoperative period (POi) and on the first and second postoperative days (PO1 and PO2), and the patients were reassessed on the discharge day. CPAP was applied for two hours and the pressure adjustment was set between 7 and 8.5 cmH2O. The oxygenation index (OI), Borg scale, pain scale and presence of thoracic drains and air losses were evaluated.

Results: There was a significant increase in the OI in the CPAP group in the POi compared to the Chest Physiotherapy (CP) group, P = 0.024. In the CP group the OI was significantly lower on PO1 (P = 0,042), than CPAP group. The air losses were significantly greater in the CPAP group in the POi and on PO1 (P = 0.001, P = 0.028), but there was no significant difference between the groups on PO2 and PO3. There was a statistically significant difference between the groups regarding the Borg scale in the POi (P < 0.001), but there were no statistically significant differences between the groups regarding the pain score.

Conclusion: CPAP after lung resection is safe and improves oxygenation, without increasing the air losses through the drains.

Clinical trial registration: NCT01285648.

CONTEXTO E OBJETIVO:: A ventilação mecânica não invasiva no período pós-operatório (PO) de ressecção pulmonar pode restaurar a capacidade residual funcional, melhorar a oxigenação e poupar os músculos inspiratórios. O objetivo deste estudo foi avaliar a eficácia da CPAP associada à fisioterapia comparada à fisioterapia unicamente após ressecção pulmonar.

ESTUDO E LOCAL:: Ensaio clínico randomizado aberto, realizado no Hospital das Clínicas da Universidade Estadual de Campinas.

MÉTODO:: Os atendimentos foram realizados nos PO imediato (POi), primeiro e segundo (PO1, PO2) dias, e a reavaliação na alta hospitalar. A CPAP foi aplicada durante duas horas e o ajuste pressórico estabelecido entre 7 e 8,5 cmH2O. Foram analisados índice de oxigenação (IO), escala de Borg e de dor, presença e perda aérea dos drenos torácicos.

RESULTADOS:: No grupo CPAP ocorreu aumento significativo do IO no POi (P = 0,024), comparado com o grupo fisioterapia respiratória. Houve redução significativa do IO no PO1 (P = 0,042) para o grupo fisioterapia respiratória, comparando-se à CPAP. A perda aérea foi significativamente maior para o grupo CPAP no POi e PO1 (0,001; 0,028), mas nos PO2 e no PO3 não houve diferença significativa entre os grupos. Foi verificada diferença significativa entre os grupos para a escala de Borg no POi (P < 0,001), porém para a escala de dor não foram verificadas diferenças significativas entre os grupos.

CONCLUSÃO:: A CPAP após ressecção pulmonar é segura e melhora a oxigenação sem aumentar a perda aérea pelos drenos. REGISTRO DE ENSAIO CLÍNICO: NCT01285648

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Conflict of interest statement

Conflict of interest: None

Figures

Figure 1
Figure 1. Study flow chart for inclusion and exclusion of patients, for the chest physiotherapy group (CP) and continuous positive airway pressure group (CPAP).
Table 1
Table 1. Analysis on the preoperative characteristics of the chest physiotherapy group (CP) and continuous positive airway pressure group (CPAP), with regard to age, smoking history, body mass index and ventilatory parameters
Figure 2
Figure 2. Graphical representation of the evolution of the oxygenation index (OI) in the preoperative period and immediate postoperative period, and on the first and second postoperative days, for the chest physiotherapy group (CP) and continuous positive airway pressure group (CPAP).
Figure 3
Figure 3. Percentages of patients with air leaks in the chest physiotherapy (CP) group and continuous positive airway pressure (CPAP) group.
Figure 4
Figure 4. Graphical representation of the incidence of dyspnea based on the Borg scale in the immediate postoperative period and on the first and second postoperative days, in the chest physiotherapy group (CP) and continuous positive airway pressure group (CPAP).
Table 2
Table 2. Percentages of patients with epidural catheters for analgesia (ECA) and analogue pain scale scores, in the chest physiotherapy (CP) group and the combination CP and continuous positive airway pressure (CPAP) group
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