Non-invasive ventilation prevents post-operative respiratory failure in patient undergoing bariatric surgery: a retrospective analysis

Abstract

Abstract Purpose Postoperative non-invasive ventilation (NIV) has been proposed as an attractive strategy to reduce morbidity in obese subjects undergoing general anesthesia. The increased body mass index (BMI) correlates with loss of perioperative functional residual capacity, expiratory reserve volume, and total lung capacity. The aim of the current study is to evaluate the efficacy of NIV in post-anaesthesia care unit (PACU) in reducing post-extubation acute respiratory failure (ARF) after biliointestinal by-pass (BIBP) in obese patients.Methods A retrospective analysis was conducted from January 2019 to December 2020 to compare acute respiratory failure within the first 72 postoperative hours and oximetry values of obese patients undergone BIBP after postoperative NIV adoption or conventional Venturi mask. Results 50 patients received NIV postoperative protocol and 57 patients received conventional Venturi Mask ventilation were included in the study. After 120 min in PACU pH, pCO2, pO2 and SpO2 resulted better in NIV Group vs Control Group (p<0.001). In the postoperative 72 hours, 1 patient (2%) in NIV group vs 7 patients (12.2%) in Control group developed acute respiratory failure. Therefore, conventional Venturi Mask ventilation resulted significantly associated (p<0.05), to postoperative ARF with an RR of 0.51 (IC 0.27-0.96). Conclusion After bariatric surgery, the short term NIV during PACU observation promotes a more rapid recovery of postoperative lung function and oxygenation in obese patients, reducing the critical care necessity in the days following surgery. Therefore, as day case surgery becomes more advocated even for the morbid obesity, it might be considered a necessary procedure.