Elsevier

Respiratory Medicine

Volume 96, Issue 9, September 2002, Pages 672-676
Respiratory Medicine

Regular Article
The effect of bi-level positive airway pressure on postoperative pulmonary function following gastric surgery for obesity

https://doi.org/10.1053/rmed.2002.1357Get rights and content
Under an Elsevier user license
open archive

Abstract

The severely obese patient has varying degrees of intrinsic reduction of expiratory flow rates and lung volumes. Thus, the severely obese patient is predisposed to postoperative atelectasis, ineffective clearing of respiratory secretions, and other pulmonary complications. This study evaluated the effect of bi-level positive airway pressure (BiPAP) on pulmonary function in obese patients following open gastric bypass surgery. Patients with a body mass index (BMI) of at least 40 kg/m2 who were undergoing elective gastric bypass were eligible to be randomized to receive either BiPAP during the first 24 h postoperatively or conventional postoperative care. Patients with significant cardiovascular and pulmonary diseases were excluded from the study. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1.0), peak expiratory flow rate (PEFR), and percent hemoglobin oxygen saturation (S pO2) were measured preoperatively, and on postoperative days 1, 2, and 3. Twenty-seven patients were entered in the study, 14 received BiPAP and 13 received conventional postoperative care. There was no significant difference preoperatively between the study and control groups in regards to age, BMI, FVC, FEV1.0. PEFR or S pO2. Postoperatively, expiratory flow was decreased in both groups. However, the FVC and FEV1.0 were significantly higher on each of the three consecutive postoperative days in the patients who received BiPAP therapy. The S pO2 was significantly decreased in the control group over the same time period. Prophylactic BiPAP during the first 12–24 h postoperatively resulted in significantly higher measures of pulmonary function in severely obese patients who had undergone elective gastric bypass surgery. These improved measures of pulmonary function, however, did not translate into fewer hospital days or a lower complication rate in our study population of otherwise healthy obese patients. Further study is necessary to determine if BiPAP therapy in the first 24 postoperative hours would be of benefit in severely obese patients with comorbid illnesses who have undergone elective gastric bypass.

Keywords

obesity, gastric bypass, pulmonary function tests, percent hemoglobin oxygen saturation.

Cited by (0)

f1

Correspondence should be addressed to: C. T. Ebeo, MD, Department of Pulmonary and Critical Care Medicine, James H. Quillen VA Medical Center 111-B, P.O. Box 4000, Mountain Home, TN 37684-4000, U.S.A. Fax: 423 979 3471; E-mail: [email protected]