Continuous positive airway pressure after major abdominal surgery: an independent discussion of the Prevention of Respiratory Insufficiency after Surgical Management trial

Abstract

Postoperative respiratory complications frequently lead to respiratory failure requiring mechanical ventilation and death,1 particularly after major abdominal surgery.1,2 Noninvasive respiratory support using continuous positive airway pressure (CPAP) is safe and reliable3–6 and may improve outcomes in patients who develop respiratory failure after major surgery.7,8 Small trials suggest that CPAP applied early after major surgery may reduce respiratory complications.9 The Prevention of Respiratory Insufficiency after Surgical Management (PRISM) trial investigated whether preventative CPAP administered within 4 h after major open abdominal surgery reduces the incidence of pneumonia, tracheal re-intubation, and/or 30 day mortality.