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Please use this identifier to cite or link to this item: http://hdl.handle.net/11055/860
Title: Physiotherapist administered, non-invasive ventilation to reduce postoperative pulmonary complications in high-risk patients following elective upper abdominal surgery; a before-and-after cohort implementation study.
Authors: Lockstone J,
Parry SM,
Denehy L,
Robertson IK,
Story D,
Parkes S,
Boden I.
ANZCA/FPM Author: ANZCA Clinical Trials Network
Story, DA
Keywords: General surgery
Non-invasive ventilation
Postoperative care
Postoperative complications
Citation: Physiotherapy. 2018 Dec 11. pii: S0031-9406(18)30651-5.
Abstract: OBJECTIVES: To (1) determine whether short, 30-minute sessions of non-invasive ventilation (NIV) is associated with fewer postoperative pulmonary complications (PPC) following elective high-risk upper abdominal surgery and (2) measure feasibility and safety of this intervention when delivered by physiotherapists. DESIGN: Prospective, pre post cohort, observational, single-centre study. SETTING: Primary referral hospital in Australia. PARTICIPANTS: A total of 182 consecutive high-risk elective upper abdominal surgery patients consisting of 101 pre cohort participants compared to 81 post cohort participants. INTERVENTIONS: Both groups received standardised preoperative physiotherapy and early postoperative mobilisation. The post cohort group received five additional 30-minute NIV sessions in the first two postoperative days. MAIN OUTCOME MEASURE: Primary outcome measure was PPC incidence within the first seven postoperative days. Secondary outcomes included feasibility and safety of physiotherapy-led NIV. RESULTS: Incidence of PPC (7% vs 18%, adjusted relative risk 0.24; 95% CI 0.10 to 0.59, p=0.002) was less in the NIV group compared to those who received no NIV. Mean time to first NIV session was 18.6 (SD 11.0) hours with 74% of participants receiving NIV within 24-hours of surgery. There were no major adverse events. CONCLUSION: These findings suggest PPC reduction may be possible with postoperative NIV following high-risk elective upper abdominal surgery. Results should be seen as hypothesis-generating associations only considering the significant limitations to this study. Physiotherapy-led NIV was delivered safely to ICU and ward patients. However, the planned protocol was not feasible and appropriate physiotherapy staffing and/or a multidisciplinary approach may be required to provide this service successfully. TRIAL REGISTRATION: LIPPSMAck POP (Lung Infection Prevention Post Surgery - Major Abdominal - with Pre Operative Physiotherapy) ANZCTR-12613000664741 (for pre cohort group only).
URI: http://hdl.handle.net/11055/860
DOI: 10.1016/j.physio.2018.12.003
PubMed URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=Physiotherapist+administered%2C+non-invasive+ventilation+to+reduce+postoperative+pulmonary+complications+in+high-risk+patients+following+elective+upper+abdominal+surgery%3B+a+before-and-after+cohort+implementation+study.
Journal Title: Physiotherapy
Type: Journal Article
Affiliates: Department of Physiotherapy, Launceston General Hospital, Launceston, TAS, 7250, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, 3053, Australia.
Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, 3053, Australia
Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, 3053, Australia
Clifford Craig Foundation, Launceston General Hospital, Launceston, TAS, Australia; School of Health Sciences, University of Tasmania, Launceston, TAS, 7250, Australia.
Anaesthesia Perioperative and Pain Medicine Unit, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
Intensive Care Unit, Launceston General Hospital, Launceston, TAS, 7250, Australia
Department of Physiotherapy, Launceston General Hospital, Launceston, TAS, 7250, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, 3053, Australia
Study/Trial: Clinical Trial
Appears in Collections:Scholarly and Clinical

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