Review article
Noninvasive positive pressure ventilation in the immediate post–bariatric surgery care of patients with obstructive sleep apnea: a systematic review,☆☆

https://doi.org/10.1016/j.soard.2017.02.009Get rights and content

Abstract

Background

Obstructive sleep apnea is common in morbidly obese patients, and noninvasive positive pressure ventilation (NIPPV) is the standard treatment. Postoperatively, NIPPV is highly effective in preventing hypoxia and apneic episodes; however, the concern of gastric distention leading to increased risk of an anastomotic dehiscence limits universal acceptance.

Objective

To perform a systematic review of the literature to determine if the use of NIPPV during immediate post–bariatric surgery care is safe.

Methods

Between January 1, 2000 and January 1, 2015 a comprehensive literature search for English-language articles was performed. Search terms were related to NIPPV use and bariatric surgery. Three reviewers independently reviewed the full-text version of the articles for relevance. Due to lack of randomized controlled trials and common incidence of zero for leak rate, a meta-analysis was not conducted.

Results

A total of 824 studies were identified for screening using our search criteria, and 811 were rejected based on exclusion criteria. Thirteen studies with 5465 patients were identified for abstract review. All articles were either favorable or equivocal on the use of NIPPV in this patient population. Comparative studies did not identify an increased rate of anastomotic dehiscence in the patients who did receive NIPPV. The use of NIPPV was associated with a decreased risk of respiratory complications but not of reintubation or unplanned intensive care unit admission.

Conclusion

This systematic review of the available literature does not provide evidence of a signal that there is an increased anastomotic dehiscence risk when NIPPV is administered during immediate post–bariatric surgery care.

Section snippets

Methods

Between January 1, 1995 and January 1, 2015, a comprehensive search of electronic databases, was performed, including Cochrane Library, MEDLINE, PubMed, BMJ Clinical Evidence, and Database of Abstracts of Reviews of Effects. The search strategy used controlled vocabulary—the National Library of Medicine’s Medical Subject Headings (MeSH). MeSH terms used were “obstructive sleep apnea” or “positive pressure ventilation” or “BiPAP” or “CPAP,” which then were combined with the following terms:

Study selection

After the initial screening process, bibliographies of key papers were searched for potentially relevant articles, and a total of 824 studies were identified. After careful assessment of these studies and based on our inclusion criteria, 87 studies were identified for full-text article evaluation (Fig. 1). Of these studies, a total of 13 met our inclusion criteria and were selected for our data extraction and critique process [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27]

Discussion

Proper diagnosis and management of OSA is particularly relevant perioperatively due to the risks of respiratory and hemodynamic complications that can lead to significant morbidity and mortality. NIPPV administration in obese patients is associated with a decreased rate of reintubation and unplanned intensive care unit admission; there were no NIPPV-related cases of anastomotic leak or serious adverse events [15], [29].

Despite this established treatment modality for OSA, the application of

Conclusion

This systematic review of the available literature did not provide evidence that there is a signal of an increased anastomotic dehiscence risk when NIPPV is administered during immediate post–bariatric surgery care.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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    Accepted as poster for Obesity Week 2016 in New Orleans, Louisiana

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    The views expressed herein are our own and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.

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