Postoperative acute respiratory failure is a major contributor to the overall risk of surgery, leading to an increase in illness and death. Postoperative acute respiratory failure often requires tracheal reintubation and invasive mechanical ventilation. It has not been established whether noninvasive ventilation (NIV) reduces the need for invasive mechanical ventilation in patients who develop hypoxemic acute respiratory failure after abdominal surgery.
In this trial conducted at 20 French intensive care units, 293 patients who had undergone abdominal surgery and developed hypoxemic respiratory failure were randomly assigned to receive standard oxygen therapy (n = 145) or NIV delivered via facial mask (n = 148). The researchers found that reintubation occurred in 33 percent of patients in the NIV group and 46 percent of patients in the standard oxygen therapy group by 7 days after randomization.
Noninvasive ventilation was associated with significantly more invasive ventilation-free days compared with standard oxygen therapy (25.4 vs 23.2 days), while fewer patients developed health care-associated infections (31 percent vs 49 percent), especially ICU acquired pneumonia. At 90 days, 15% of patients in the NIV group had died, compared to 22 percent in the standard oxygen therapy group.
“Among patients with hypoxemic respiratory failure following abdominal surgery, use of NIV compared with standard oxygen therapy reduced the risk of tracheal reintubation within 7 days. These findings support use of NIV in this setting,” the authors write.