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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

Lockstone, J, Parry, SM, Denehy, L, Robertson, IK, Story, D, Parkes, S and Boden, I 2019 , '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 , doi: 10.1016/j.physio.2018.12.003.

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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.

Item Type: Article
Authors/Creators:Lockstone, J and Parry, SM and Denehy, L and Robertson, IK and Story, D and Parkes, S and Boden, I
Keywords: general surgery, non-invasive ventilation, postoperative care, postoperative complications
Journal or Publication Title: Physiotherapy
Publisher: Elsevier Ltd
ISSN: 0031-9406
DOI / ID Number: 10.1016/j.physio.2018.12.003
Copyright Information:

© 2018 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

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