Clinical application of postoperative non-invasive positive pressure ventilation after lung cancer surgery.

Objective: The purpose of this study was to clarify the clinical efficacy of postoperative non-invasive positive pressure ventilation (PONIV) after pulmonary lobectomy in patients with lung cancer.

Methods: From August 2010 and July 2015, 143 patients with lung cancer who underwent pulmonary lobectomy were retrospectively reviewed. PONIV was used immediately after surgery until the morning of postoperative day (POD) 1. Arterial blood gas was analyzed before and just after surgery (POD0) and on POD1. Oxygenation ability was perioperatively assessed by PaO/FiO ratio, alveolar-arterial oxygen difference (A-aDO), and respiratory index (A-aDO/PaO).

Results: 112 patients received PONIV. From POD0 to POD1, the PaO/FiO ratio significantly improved in all patients who received PONIV (333 ± 83 to 359 ± 47 mmHg, p = 0.004). Moreover, A-aDO and respiratory index significantly decreased following PONIV. PONIV significantly improved the PaO/FiO ratio in patients with PaO/FiO ratio of ≤ 300 on POD0, older age (≥ 70 years), higher body mass index (≥ 25 kg/m), and longer one-lung ventilation time (≥ 180 min). There was no respiratory failure requiring mechanical ventilation and no mortality.

Conclusions: PONIV effectively improved oxygenation in patients undergoing pulmonary lobectomy in patients with poor status, especially in patients with PaO/FiO ratio of ≤ 300 on POD0. PONIV could be an option of perioperative management for major thoracic surgery.