Noninvasive Ventilation in the Perioperative Period
Noninvasive ventilation (NIV) refers to the delivery of positive airway pressure in a spontaneously breathing patient without the use of endotracheal intubation. Many ventilation modes can be used for NIV, but the two most common modes include continuous positive airway pressure ventilation (CPAP) and bilevel positive airway pressure ventilation (BPAP). NIV has been shown to clearly benefit several acute medical conditions, but its role in the perioperative patient is less well defined and requires individual consideration of comorbidities and surgical anatomy. In select surgical populations, the use of NIV may preclude the need for endotracheal intubation and mechanical ventilation, thus reducing nosocomial infections and ICU length of stay while preserving mobility, speech, and cough. When considering NIV, appropriate patient selection and early recognition of NIV failure are integral to its success. Heightened recognition of postoperative vulnerability to hypercapnia, atelectasis, and undiagnosed sleep apnea, combined with accumulating data demonstrating safety and efficacy in multiple subsets of surgical patients, has contributed to the increasing use of NIV in the perioperative period. While further evidence is needed, current data suggests that NIV is safe in patients with proximal foregut anastomoses, without increasing the risk of an anastomotic leak.
KeywordsCPAP BPAP BIPAP NIV NPPV Noninvasive positive pressure ventilation Noninvasive ventilation STOP-Bang Obstructive sleep apnea Postoperative respiratory failure
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