Efficacy of continuous positive airway pressure and incentive spirometry on respiratory functions during the postoperative period following supratentorial craniotomy: A prospective randomized controlled study.
STUDY OBJECTIVE
Volume controlled ventilation with low PEEP is used in neuro-anesthesia to provide constant PaCO2 levels and prevent raised intracranial pressure. Therefore, neurosurgery patients prone to atelectasis formation, however, we could not find any study that evaluates prevention of postoperative pulmonary complications in neurosurgery.


DESIGN
A prospective, randomized controlled study.


SETTING
Intensive care unit in a university hospital in Istanbul.


PATIENTS
Seventy-nine ASAI-II patients aged between 18 and 70years scheduled for elective supratentorial craniotomy were included in the study.


INTERVENTIONS
Patients randomized into 3 groups after surgery. The Group IS (n=20) was treated with incentive spirometry 5 times in 1min and 5min per hour, the Group CPAP (n=20) with continuous positive airway pressure 10 cmH2O pressure and 0.4 FiO2 via an oronasal mask 5min per hour, and the Group Control (n=20) 4L·min-1O2 via mask; all during the first 6h postoperatively. Respiratory functions tests and arterial blood gases analysis were performed before the induction of anesthesia (Baseline), 30min, 6h, 24h postoperatively.


MAIN RESULTS
The IS and CPAP applications have similar effects with respect to FVC values. The postoperative 30min FEV1 values were statistically significantly reduced compared to the Baseline in all groups (p<0.0001). FEV1 values were statistically significantly increased at the postoperative 24h compared to the postoperative 30min in the Groups IS and CPAP (p<0.0001). This increase, however, was not observed in the Group Control, and the postoperative 24h FEV1 values were statistically significantly lower in the Group Control compared to the Group IS (p=0.015).


CONCLUSION
Although this study is underpowered to detect differences in FEV1 values, the postoperative 24h FEV1 values were significantly higher in the IS group than the Control group and this difference was not observed between the CPAP and Control groups. It might be evaluate a favorable effect of IS in neurosurgery patients. But larger studies are needed to make a certain conclusion.
['Sah|Hulya Kahraman|HK|', 'Akcil|Eren Fatma|EF|', 'Tunali|Yusuf|Y|', 'Vehid|Hayriye|H|', 'Dilmen|Ozlem Korkmaz|OK|']
D000328:Adult D000769:Anesthesia, Inhalation D018685:Anesthetics, Inhalation D001784:Blood Gas Analysis D045422:Continuous Positive Airway Pressure D003399:Craniotomy D005260:Female D005541:Forced Expiratory Volume D006801:Humans D019586:Intracranial Hypertension D008168:Lung D008297:Male D008397:Masks D008738:Methyl Ethers D008875:Middle Aged D011182:Postoperative Care D011183:Postoperative Complications D011446:Prospective Studies D001261:Pulmonary Atelectasis D012119:Respiration D012129:Respiratory Function Tests D000077149:Sevoflurane D013147:Spirometry D016896:Treatment Outcome D055815:Young Adult
Continuous positive airway pressure Incentive spirometry Craniotomy Postoperative pulmonary complications Pulmonary function tests