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Squadrone V, Coha M, Cerutti E, et al. Continuous Positive Airway Pressure for Treatment of Postoperative Hypoxemia: A Randomized Controlled Trial. JAMA. 2005;293(5):589–595. doi:10.1001/jama.293.5.589
Caring for the Critically Ill Patient Section Editor: Deborah J. Cook, MD, Consulting Editor, JAMA.
Author Affiliations: Dipartimento di Anestesia,
Azienda Ospedaliera S.Giovanni Battista-Molinette, Università di Torino
(Drs Squadrone, Coha, Cerutti, Schellino, Occella, and Ranieri), Servizio
di Anestesia e Rianimazione, Ospedale Civile di Chivasso (Dr Biolino), Servizio
di Anestesia e Rianimazione, Ospedale Civile di Ivrea (Dr Belloni), Servizio
di Anestesia e Rianimazione, Ospedale Civile di Pinerolo (Dr Vilianis), Servizio
di Anestesia e Rianimazione, Ospedale S. Croce di Monacalieri (Dr Fiore),
and Dipartimento di Sanità Pubblica e Microbiologia, Università
di Torino (Dr Cavallo), Italy.
Context Hypoxemia complicates the recovery of 30% to 50% of patients after abdominal
surgery; endotracheal intubation and mechanical ventilation may be required
in 8% to 10% of cases, increasing morbidity and mortality and prolonging intensive
care unit and hospital stay.
Objective To determine the effectiveness of continuous positive airway pressure
compared with standard treatment in preventing the need for intubation and
mechanical ventilation in patients who develop acute hypoxemia after elective
major abdominal surgery.
Design and Setting Randomized, controlled, unblinded study with concealed allocation conducted
between June 2002 and November 2003 at 15 intensive care units of the Piedmont
Intensive Care Units Network in Italy.
Patients Consecutive patients who developed severe hypoxemia after major elective
abdominal surgery. The trial was stopped for efficacy after 209 patients had
Interventions Patients were randomly assigned to receive oxygen (n = 104)
or oxygen plus continuous positive airway pressure (n = 105).
Main Outcome Measures The primary end point was incidence of endotracheal intubation; secondary
end points were intensive care unit and hospital lengths of stay, incidence
of pneumonia, infection and sepsis, and hospital mortality.
Results Patients who received oxygen plus continuous positive airway pressure
had a lower intubation rate (1% vs 10%; P = .005;
relative risk [RR], 0.099; 95% confidence interval [CI], 0.01-0.76) and had
a lower occurrence rate of pneumonia (2% vs 10%, RR, 0.19; 95% CI, 0.04-0.88; P = .02), infection (3% vs 10%, RR, 0.27; 95%
CI, 0.07-0.94; P = .03), and sepsis (2%
vs 9%; RR, 0.22; 95% CI, 0.04-0.99; P = .03)
than did patients treated with oxygen alone. Patients who received oxygen
plus continuous positive airway pressure also spent fewer mean (SD) days in
the intensive care unit (1.4 [1.6] vs 2.6 [4.2], P = .09)
than patients treated with oxygen alone. The treatments did not affect the
mean (SD) days that patients spent in the hospital (15  vs 17 , respectively; P = .10). None of those treated with oxygen plus
continuous positive airway pressure died in the hospital while 3 deaths occurred
among those treated with oxygen alone (P = .12).
Conclusion Continuous positive airway pressure may decrease the incidence of endotracheal
intubation and other severe complications in patients who develop hypoxemia
after elective major abdominal surgery.
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