Background

Postoperative pulmonary complications, including pneumonia, are a substantial cause of morbidity. We hypothesised that routine noninvasive respiratory support was associated with a lower incidence of pneumonia after surgery.

Methods

Systematic review and meta-analysis of RCTs comparing the routine use of continuous positive airway pressure (CPAP), noninvasive ventilation (NIV), or high-flow nasal oxygen (HFNO) against standard postoperative care in the adult population. We searched MEDLINE (PubMed), EMBASE, and CENTRAL from the start of indexing to July 27, 2021. Articles were reviewed and data extracted in duplicate, with discrepancies resolved by a senior investigator. The primary outcome was pneumonia, and the secondary outcome was postoperative pulmonary complications. We calculated risk difference (RD) with 95% confidence intervals using DerSimonian and Laird random effects models. We assessed risk of bias using the Cochrane risk of bias tool.

Results

From 18 513 records, we included 38 trials consisting of 9782 patients. Pneumonia occurred in 214/4403 (4.9%) patients receiving noninvasive respiratory support compared with 216/3937 (5.5%) receiving standard care (RD −0.01 [95% confidence interval: −0.02 to 0.00]; I²=8%; P=0.23). Postoperative pulmonary complications occurred in 393/1379 (28%) patients receiving noninvasive respiratory support compared with 280/902 (31%) receiving standard care (RD −0.11 [−0.23 to 0.01]; I²=79%; P=0.07). Subgroup analyses did not identify a benefit of CPAP, NIV, or HFNO in preventing pneumonia. Tests for publication bias suggest six unreported trials.

Conclusion

The results of this evidence synthesis do not support the routine use of postoperative CPAP, NIV, or HFNO to prevent pneumonia after surgery in adults.

Clinical trial registration

PROSPERO: CRD42019156741.

中文翻译：

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择期手术后常规术后无创呼吸支持和肺炎：随机试验的系统评价和荟萃分析

背景

术后肺部并发症，包括肺炎，是发病的重要原因。我们假设常规无创呼吸支持与术后肺炎的发生率较低有关。

方法

对成人人群中常规使用持续气道正压通气 (CPAP)、无创通气 (NIV) 或高流量鼻氧 (HFNO) 与标准术后护理进行比较的随机对照试验的系统回顾和荟萃分析。从索引开始到 2021 年 7 月 27 日，我们检索了 MEDLINE (PubMed)、EMBASE 和 CENTRAL。文章经过审查并一式两份提取数据，差异由一名高级研究员解决。主要结局是肺炎，次要结局是术后肺部并发症。我们使用 DerSimonian 和 Laird 随机效应模型计算了具有 95% 置信区间的风险差异 (RD)。我们使用 Cochrane 偏倚风险工具评估偏倚风险。

结果

从 18 513 条记录中，我们纳入了 38 项试验，包括 9782 名患者。接受无创呼吸支持的患者有 214/4403 (4.9%) 例肺炎发生，而接受标准治疗的患者有 216/3937 (5.5%) 例（RD -0.01 [95% 置信区间：-0.02 至 0.00]；I ² =8%；P =0.23)。接受无创呼吸支持的患者术后肺部并发症为 393/1379 (28%)，而接受标准治疗的患者为 280/902 (31%) (RD -0.11 [-0.23 to 0.01]; I ² =79%; P =0.07) . 亚组分析未发现 CPAP、NIV 或 HFNO 在预防肺炎方面的益处。发表偏倚测试表明有六项未报告的试验。

结论

该证据综合结果不支持常规使用术后 CPAP、NIV 或 HFNO 来预防成人术后肺炎。

临床试验注册

普洛斯彼罗：CRD42019156741。