University Of Tasmania
151842 - Non invasive positive airway pressure thErapy to reduce postoperative Pre proof.pdf (711.98 kB)

Non-invasive positive airway pressure thErapy to reduce postoperative lung complications following upper abdominal surgery (NIPPER PLUS): a pilot randomised control trial

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journal contribution
posted on 2023-05-21, 10:51 authored by Lockstone, J, Parry, SM, Denehy, L, Iain RobertsonIain Robertson, Story, D, Ianthe BodenIanthe Boden

Objectives:Postoperative pulmonary complications (PPC) are a common serious complication following upper abdominal surgery. Postoperatively, physiotherapy-led non-invasive ventilation (NIV) may be a promising method to reduce PPC incidence. The objectives of this pilot trial were to examine preliminary effectiveness, feasibility and safety of additional intermittent physiotherapy-led NIV compared to continuous high-flow nasal cannula oxygen therapy (HFNC) alone.

Design:Single-centre, assessor-blinded, parallel-group, pilot randomised control trial.

Setting:Primary-referral hospital in Australia.

Participants:130 high-risk patients undergoing upper abdominal surgery.

Interventions:Continuous HFNC for 48-hours following surgical extubation, or HFNC plus five 30-minute physiotherapy-led NIV sessions.

OutcomesPPC incidence, trial feasibility and safety.

Results:PPC incidence was similar between groups (HFNC alone 12/65 (18%) vs HFNC plus NIV 10/64 (16%) adjusted HR 0.95; 95% CI 0.40-2.29). Delivery of HFNC as per-protocol was achieved in 81% (n=105) of all participants. Physiotherapy-led NIV initiated within four-hours of surgical extubation was achieved in 81% (n=52) of intervention group participants, with a mean 4.2 (SD 1.3) total number of NIV sessions delivered in the first two postoperative days. NIV was delivered as per-protocol in 52% of this cohort. Two episodes of severe hypotension during NIV requiring medical intervention were reported.

Conclusion:Delivery of continuous HFNC was feasible. Delivery of NIV within four-hours of extubation was achieved and delivered safely with <1% adverse events. The planned NIV intervention of five sessions within two postoperative days was not feasible. The results of this pilot study have informed the decision not to proceed to a fully powered trial.


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School of Health Sciences



Place of publication

United Kingdom

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© 2021 Published by Elsevier.

Repository Status

  • Open

Socio-economic Objectives

Prevention of human diseases and conditions; Allied health therapies (excl. mental health services); Inpatient hospital care