Continuous positive airway pressure for treatment of respiratory complications after abdominal surgery: a systematic review and meta-analysis

Ann Surg. 2008 Apr;247(4):617-26. doi: 10.1097/SLA.0b013e3181675829.


Objective: We evaluated the potential benefit of continuous positive airway pressure (CPAP) to prevent postoperative pulmonary complications (PPCs), atelectasis, pneumonia, and intubation in patients undergoing major abdominal surgery.

Summary background data: PPCs are common during the postoperative period and may be associated with a high morbidity rate. Efficacy of CPAP to prevent PPCs occurrence is controversial.

Methods: Medical literature databases were searched for randomized controlled trials examining the use of CPAP versus standard therapy in patients undergoing abdominal surgery. The meta-analysis estimated the pooled risk ratio and the number needed to treat to benefit (NNTB) for PPCs, atelectasis, and pneumonia.

Results: The meta-analysis was carried out over 9 randomized controlled trials. Overall, CPAP significantly reduced the risk of (1) PPCs (risk ratio, 0.66; 95% confidence interval [CI], 0.52-0.85) with a corresponding NNTB of 14.2 (95% CI, 9.9-32.4); (2) atelectasis (risk ratio, 0.75; 95% CI, 0.58-0.97; NNTB, 7.3; 95% CI, 4.4-64.5); (3) pneumonia (risk ratio, 0.33; 95% CI, 0.14-0.75; NNTB, 18.3; 95% CI, 14.4-48.8). In all cases the variation in risk ratio attributable to heterogeneity was negligible, although there was some evidence of publication bias.

Conclusions: This systematic review suggests that CPAP decreases the risk of PPCs, atelectasis, and pneumonia and supports its clinical use in patients undergoing abdominal surgery.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Abdominal Cavity / surgery*
  • Continuous Positive Airway Pressure*
  • Humans
  • Intubation, Intratracheal
  • Pneumonia / etiology
  • Pneumonia / prevention & control
  • Pneumonia / therapy
  • Pulmonary Atelectasis / etiology
  • Pulmonary Atelectasis / prevention & control
  • Pulmonary Atelectasis / therapy
  • Randomized Controlled Trials as Topic
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / prevention & control
  • Respiratory Insufficiency / therapy*
  • Surgical Procedures, Operative / adverse effects*