ANTICIPUSC
Trial question
What is the role of prophylactic noninvasive ventilation in patients at high-risk of postoperative pulmonary complications?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
20.0% female
80.0% male
N = 253
253 patients (50 female, 203 male)
Inclusion criteria: patients at high risk of postoperative pulmonary complications after elective or semi-urgent surgery with an Assess Respiratory Risk in Surgical Patients in Catalonia score ≥ 45
Key exclusion criteria: obstetrical interventions; pregnancy; surgery under local anesthesia; organ transplantation; outpatient surgery
Interventions
N=125 prophylactic noninvasive ventilation (intermittent prophylactic face-mask noninvasive ventilation for 6-8 hours/day)
N=128 usual postoperative care (standard care after surgery in postoperative unit)
Primary outcome
Rate of in-hospital acute respiratory failure within 7 days after surgery
24
27.3
27.3 %
20.5 %
13.7 %
6.8 %
0.0 %
Prophylactic noninvasive ventilation
Usual postoperative care
No significant difference ↔
No significant difference in the rate of in-hospital acute respiratory failure within 7 days after surgery (24% vs. 27.3%; OR 0.97, 95% CI 0.9 to 1.04)
Secondary outcomes
No significant difference in Atelectasis (48.8% vs. 57%; ARD -8.2, 95% CI -21.81 to 5.41)
No significant difference in Re-intubation (7.2% vs. 6.3%; AD 0.9%, 95% CI -4.57 to 6.37)
Conclusion
In patients at high risk of postoperative pulmonary complications after elective or semi-urgent surgery with an Assess Respiratory Risk in Surgical Patients in Catalonia score ≥ 45, prophylactic noninvasive ventilation was not superior to usual postoperative care with respect to the rate of in-hospital acute respiratory failure within 7 days after surgery.
Reference
Stanislas Abrard, Emmanuel Rineau, Valerie Seegers et al. Postoperative prophylactic intermittent noninvasive ventilation versus usual postoperative care for patients at high risk of pulmonary complications: a multicentre randomised trial. Br J Anaesth. 2023 Jan;130(1):e160-e168.
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