B-004PROPHYLACTIC CONTINUOUS POSITIVE AIRWAY PRESSURE AFTER PULMONARY LOBECTOMY FOR LUNG CANCER: A RANDOMIZED CONTROLLED TRIAL

Abstract

Objectives: The utility of continuous positive airway pressure (cPAP) after pulmonary resection is debated. The aim of this trial was to evaluate the clinical outcomes in patients treated with prophylactic cPAP after pulmonary lobectomy for lung cancer. The primary end point was the aggregate rate of cardiopulmonary adverse effects; secondary end‐points were cardio‐respiratory functional parameters, length of hospital stay and 30‐day mortality. Methods: Design: prospective randomized, controlled, trial approved by the local ethical committee and registered on‐line. Setting: one university hospital and one tertiary hospital. Patients: adults with stage I non‐small cell lung cancer scheduled for pulmonary lobectomy. Intervention: continuous positive airway pressure, tailored on body mass index, administered 6 h a day during the first 3 postoperative days. Study arms: study group received intervention and standard physiotherapy (early mobilization and assisted cough); the control group received standard physiotherapy. Measurements: number of postoperative atelectasis, pneumonia, prolonged air leak (>7 days) and cardiac complications were summarized in the aggregate rate; cardio‐respiratory and functional parameters were also tested during the first 5 postoperative days. Results: Randomization allocated 81 patients to the study group and 82 to the control group. The 2 groups resulted homogeneous in demographic and physiological characteristics except higher rate of male (P=0.043) and lower FEV1% (P=0.044) in the control group. Lobectomy types, approaches (open vs VATS), operative time and allocation (university vs tertiary hospital) were homogeneous between the 2 arms. The mean effective application of the intervention was 11.5 (±3.9) h. The study group had lower aggregate complication rate (P=0.005); lower pulmonary complication rate (P=0.04) and lower hospital stay (P=0.031). None of the cardio‐respiratory and functional parameters resulted in significantvs differences between groups at any postoperative time‐point; there was no operative mortality in both groups. Conclusions: Prophylactic postoperative cPAP significantly reduced cardiorespiratory complications after pulmonary lobectomy.