Non-Invasive Pressure Support Ventilation in Major Lung Resection for High Risk Patients: Does It Matter?

Abstract

Aims: Patients with severe reduction of pulmonary function have an increased operative risk for major lung resection. Little evidence is given for prophylactic treatment with non-invasive pressure support ventilation (NIPSV) in these high risk patients. Objective(s): Influence of NIPSV on mortality and morbidity of patients undergoing major lung resection was evaluated. In a prospective randomised single centre clinical trial patients were included if predictive postoperative FEV1 was between 0.9 and 1,3l. Patients and Methods: All patients were evaluated by perfusion-ventilation scan and exercise testing under maximal bronchiolytic therapy. All patients were trained preoperatively with NIPSV. Postoperatively, patients were randomly assigned either for continuation of NIPSV (NIPSV group) or for standard treatment only (Control group). Result(s): After maximal bronchiolytic therapy 21 patients were eligible for the study. Median FEV1 was 1.10l with a range of 0.92-1.27l. In 14 patients a lobectomy, in 6 patients a pneumonectomy and in one patient a segmentectomy was performed. Clinical outcome with respect to need for repeated invasive ventilation, incidence of pneumonia and duration of hospital stay was not significant different between both groups. None of the patients died, pulmonary complications occurred in 4 patients (19.1%). Conclusion(s): The preoperative conditioning with NIPSV is a suitable tool for patients with severe limited pulmonary function undergoing major lung surgery. As we observed in this high risk group no mortality and a low morbidity the results are promising. For evaluation of the expected positive effect of postoperative continuation of NIPSV further patient recruitment is necessary.