Premium
CT25
CPAP: AN OVERVIEW AND CURRENT APPLICATIONS
Author(s) -
Shaw G. M.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04115_23.x
Subject(s) - medicine , atelectasis , continuous positive airway pressure , relative risk , mechanical ventilation , perioperative , anesthesia , intubation , afterload , cardiology , lung , hemodynamics , confidence interval , obstructive sleep apnea
CPAP was first used for over 70 years ago and confers benefit to patients through a number of different mechanisms:• Reduction in left ventricular afterload • Reduction in work of breathing • Improved work sharing of fatiguing muscle groups • Maintenance of lung volumes with improved ventilation perfusion matching and improvement in oxygen • Prevention of upper airway obstruction • Reduced stress and ‘biological’ injuryIn a study of prophylactic CPAP following major abdominal surgery, those randomised to CPAP had a lower intubation rate (1% vs 10%, Relative risk [RR], 0.099, 95% CI, 0.01–0.76, p = 0.005) and had a lower occurrence rate of pneumonia (2% vs 10%, RR, 0.19; 95% CI, 0.04–0.88, p = 0.02), infection (3% vs 10%, RR, 0.27; 95% CI, 0.07–0.94, p = 0.03), and sepsis (2% vs 9%, RR, 0.22, 95% CI, 0.04–0.99, p = 0.03) than did patients treated with oxygen alone 1 . The benefit of CPAP, largely through a reduction in the need for intubation and ventilation, are now clearly established in acute cardiogenic pulmonary oedema. A recent meta‐analysis showed CPAP reduces mortality (RR, 0.59, 95% CI 0.38–0.90, p = 0.15) and the need for mechanical ventilation (RR, 0.44, CI, 0.29–0.66, p = 0.0003) 2 . Summary The perioperative cardiac surgical patient will frequently have impaired left ventricular function, pulmonary oedema, or atelectasis, all of which may be improved with the application of CPAP. Hence CPAP is likely to confer significant benefits through reduction in intubation, ventilation associated pneumonia, and mortality in the immediate post operative period.