Prophylactic nCPAP in the PACU Following Elective Laparotomy for Bowel Surgery

NCT ID: NCT02077842

Last Updated: 2016-10-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-05-31

Study Completion Date

2016-10-31

Brief Summary

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The purpose of this study is to determine whether prophylactic nasal continuous positive airway pressure (nCPAP) in the post-anaesthesia care unit (PACU) improves post-operative pulmonary function following elective bowel surgery. The investigators hypothesize that one hour of nCPAP in the PACU will result in a higher partial pressure of arterial oxygen (PaO2) when compared to the standard treatment of low flow oxygen applied by face mask.

Detailed Description

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Post-operative pulmonary complications, such as hypoxemia, pneumonia and respiratory failure, occur in 5-10% of patients following abdominal surgery. These post-operative pulmonary complications result in increased morbidity, mortality, ICU admission, length of hospital stay and resource use.

CPAP has shown to be an effective treatment for hypoxemia following abdominal surgery. It decreases atelectasis formation the risk of pneumonia. Application of nCPAP to treat hypoxemic respiratory failure following thoraco-abdominal surgery has shown to decrease endotracheal intubation.

Nasal CPAP has shown to be effective prophylaxis following elective cardiac and thoraco-abdominal aortic surgery. It reduces the incidence of hypoxemia, pneumonia, re-intubation and re-admission to the ICU. It has also shown to decrease the length of hospital stay.

The use of nCPAP immediately post-operatively in the PACU following abdominal surgery has not been evaluated. Nasal CPAP is better tolerated than full face mask CPAP. It allows for effective clearance of respiratory secretions, improved communication and decreases claustrophobic sensation. The PACU is a transition period from general anaesthesia into the post-operative recovery phase. During this time, residual anaesthetic causes decreased level of consciousness and sub-optimal respiratory effort. Reversal agent for neuromuscular blockade has often not reached its peak effect. Inadequate pain control may further decrease respiratory effort. This transition period may be when maximal atelectasis of alveolar lung units occurs. This time period may be optimal for the application of nCPAP for prophylaxis against hypoxemia. It may improve post-operative pulmonary function which could decrease post-operative morbidity, mortality, length of hospital stay and resource use.

Conditions

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Postoperative Pulmonary Atelectasis Surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Nasal CPAP

The experimental group will receive nasal continuous positive airway pressure at 10cmH20 for one hour in the Post Anesthetic Care Unit.

Group Type EXPERIMENTAL

Nasal Continuous Positive Airway Pressure

Intervention Type DEVICE

Nasal continuous positive airway pressure at 10 cmH2O

Low Flow Oxygen

The control group will receive standard therapy of low flow oxygen via simple mask at 8 litres per minute.

Group Type ACTIVE_COMPARATOR

Low Flow Oxygen

Intervention Type DEVICE

Low flow oxygen delivered via face mask at 8 litres per minute

Interventions

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Nasal Continuous Positive Airway Pressure

Nasal continuous positive airway pressure at 10 cmH2O

Intervention Type DEVICE

Low Flow Oxygen

Low flow oxygen delivered via face mask at 8 litres per minute

Intervention Type DEVICE

Other Intervention Names

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Resmed, VPAP III ST-A, manufactured by ResMed LTD

Eligibility Criteria

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Inclusion Criteria

* patients scheduled to undergo laparotomy for elective bowel surgery

Exclusion Criteria

* age \< 18 years
* postoperative admission to the intensive care unit
* a history of allergy/intolerance to Ametop
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Saskatchewan

OTHER

Sponsor Role lead

Responsible Party

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William McKay

Anesthesiologist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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William McKay, M.D.

Role: PRINCIPAL_INVESTIGATOR

Faculty

Locations

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Royal University Hospital

Saskatoon, Saskatchewan, Canada

Site Status

Countries

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Canada

References

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Zarbock A, Mueller E, Netzer S, Gabriel A, Feindt P, Kindgen-Milles D. Prophylactic nasal continuous positive airway pressure following cardiac surgery protects from postoperative pulmonary complications: a prospective, randomized, controlled trial in 500 patients. Chest. 2009 May;135(5):1252-1259. doi: 10.1378/chest.08-1602. Epub 2008 Nov 18.

Reference Type BACKGROUND
PMID: 19017864 (View on PubMed)

Kindgen-Milles D, Muller E, Buhl R, Bohner H, Ritter D, Sandmann W, Tarnow J. Nasal-continuous positive airway pressure reduces pulmonary morbidity and length of hospital stay following thoracoabdominal aortic surgery. Chest. 2005 Aug;128(2):821-8. doi: 10.1378/chest.128.2.821.

Reference Type BACKGROUND
PMID: 16100174 (View on PubMed)

Ferreyra GP, Baussano I, Squadrone V, Richiardi L, Marchiaro G, Del Sorbo L, Mascia L, Merletti F, Ranieri VM. Continuous positive airway pressure for treatment of respiratory complications after abdominal surgery: a systematic review and meta-analysis. Ann Surg. 2008 Apr;247(4):617-26. doi: 10.1097/SLA.0b013e3181675829.

Reference Type BACKGROUND
PMID: 18362624 (View on PubMed)

Other Identifiers

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13-192

Identifier Type: -

Identifier Source: org_study_id