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Review
. 2023 Dec 30;14(1):56.
doi: 10.3390/jpm14010056.

Personalized Noninvasive Respiratory Support in the Perioperative Setting: State of the Art and Future Perspectives

Giovanni Misseri  1 , Luciano Frassanito  2 , Rachele Simonte  3 , Tommaso Rosà  2   4 , Domenico Luca Grieco  2   4 , Alessandra Piersanti  2 , Edoardo De Robertis  3 , Cesare Gregoretti  1   5
Affiliations
Review

Personalized Noninvasive Respiratory Support in the Perioperative Setting: State of the Art and Future Perspectives

Giovanni Misseri et al. J Pers Med. .

Abstract

Background: Noninvasive respiratory support (NRS), including high-flow nasal oxygen therapy (HFNOT), noninvasive ventilation (NIV) and continuous positive airway pressure (CPAP), are routinely used in the perioperative period. Objectives: This narrative review provides an overview on the perioperative use of NRS. Preoperative, intraoperative, and postoperative respiratory support is discussed, along with potential future areas of research. Results: During induction of anesthesia, in selected patients at high risk of difficult intubation, NIV is associated with improved gas exchange and reduced risk of postoperative respiratory complications. HFNOT demonstrated an improvement in oxygenation. Evidence on the intraoperative use of NRS is limited. Compared with conventional oxygenation, HFNOT is associated with a reduced risk of hypoxemia during procedural sedation, and recent data indicate a possible role for HFNOT for intraoperative apneic oxygenation in specific surgical contexts. After extubation, "preemptive" NIV and HFNOT in unselected cohorts do not affect clinical outcome. Postoperative "curative" NIV in high-risk patients and among those exhibiting signs of respiratory failure can reduce reintubation rate, especially after abdominal surgery. Data on postoperative "curative" HFNOT are limited. Conclusions: There is increasing evidence on the perioperative use of NRS. Use of NRS should be tailored based on the patient's specific characteristics and type of surgery, aimed at a personalized cost-effective approach.

Keywords: CPAP; HFNOT; ICU; mechanical ventilation; noninvasive respiratory support (NRS); noninvasive ventilation (NIV); perioperative care; postoperative pulmonary complications.

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Conflict of interest statement

Giovanni Misseri declares a patent in association with the University of Palermo, Italy (No 102019000020532, Italian Ministry of Economic Development); Luciano Frassanito received honoraria from Edwards Lifesciences Ltd. for scientific advice; Domenico Luca Grieco received honoraria from GE Healthcare, Intersurgical, Fisher&Paykel, Gilead, and Pfizer for lectures, and discloses research grants by GE Healthcare and Fisher&Paykel. Cesare Gregoretti received honoraria for lectures or consultancies from Vivisol, Philips, Mindray, and Air Liquid, and declares a patent in association with the University of Palermo, Italy (No 102019000020532, Italian Ministry of Economic Development). Edoardo De Robertis received honoraria from Drager, GE, Baxter, MSD, Fresenius, and Fisher&Paykel for lectures or consultancies. All the other authors declare no conflicts of interest. All other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Infographic on the personalized perioperative use of noninvasive respiratory support (CPAP: continuous positive airway pressure; CO2: carbon dioxide; HDU: high-dependency care unit; ICU: intensive care unit; NIV: noninvasive ventilation; NRS: noninvasive respiratory support, PACU: postanesthesia care unit; PPCs: postoperative pulmonary complications; THRIVE: transnasal humidified rapid-insufflation ventilatory exchange).
Figure 2
Figure 2
Simplified algorithm for the perioperative use of noninvasive respiratory support.
See this image and copyright information in PMC

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