Italian researchers halted multicenter clinical trial a evaluating the use of continuous positive airway pressure (CPAP) and oxygen in patients who developed hypoxemia after elective abdominal surgery, when an independent safety committee found that the patients receiving CPAP were faring significantly better than those receiving oxygen without CPAP.
The control group of 104 patients received standard oxygen therapy: oxygen administered through a face mask postoperatively. The 105 patients in the intervention group received oxygen and received CPAP administered through a transparent, latex-free helmet. Both groups received oxygen or the oxygen plus CPAP until they were able to maintain sufficient oxygenation on their own.
Among patients who received CPAP postoperatively, only one needed intubation, compared with 10 of those who didn't receive CPAP. The rates of pneumonia were similar, with only two cases in the intervention group, versus 10 in the control group. And there were three surgical-wound infections in the CPAP group, compared with 11 in the control group. In addition, more control patients developed sepsis as a result of pneumonia or a surgical-wound infection (nine cases versus two), and control patients stayed in the ICU about one day longer. All of the patients in the CPAP group left the hospital alive, but three patients in the oxygen-alone group died.
CPAP appears to be a safe, low-cost intervention that can reduce life-threatening complications after surgery. -Fran Mennick, BSN, RN
Squadrone V, et al. JAMA 2005;293(5): 589-95.