© Springer International Publishing Switzerland 2016
Antonio M. Esquinas (ed.)Noninvasive Mechanical Ventilation10.1007/978-3-319-21653-9_5959. Intraoperative Noninvasive Ventilation: Key Technical and Practical Recommendations
(1)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, Milan, 20132, Italy
Keywords
Noninvasive ventilationAcute respiratory failureSurgeryTracheal intubationDifficult airwayAbbreviations
ARF
Acute respiratory failure
COPD
Chronic obstructive pulmonary disease
CPAP
Continuous positive airway pressure
FOB
Fiber-optic bronchoscopy
NIV
Noninvasive ventilation
NPPV
Noninvasive positive pressure ventilation
59.1 Introduction
Noninvasive ventilation (NIV) has traditionally been applied to treat acute respiratory failure (ARF) in pulmonary wards, intensive care units, and emergency departments [1]. New indications (such as prevention of ARF) and new settings (pre-hospital and ordinary wards) have been proposed and evaluated. In particular, NIV has been evaluated in the perioperative period to prevent or to treat postoperative pulmonary complications and ARF. NIV proved effective in improving relevant outcomes in surgical patients, especially when applied in high-risk patients in the postoperative period [2].
Furthermore, a growing number of studies have reported the application of NIV in the operating theatre. During surgery, NIV could be of help at least in four conditions: to prevent ARF in patients in whom tracheal intubation must be avoided or was refused, to treat ARF in the same patients, to improve ventilation in sedated patients, or as an aid for tracheal intubation/airway management [3–6]. In the following section, the main indications and available evidence are reported. Relevant technical and practical aspects will be addressed.
59.2 Discussion and Analysis
59.2.1 NIV to Prevent ARF During Surgery in Patients with Respiratory Diseases
In patients with a very labile respiratory function, postoperative weaning from mechanical ventilation and tracheal extubation can be difficult or even impossible. On the other hand, avoiding intraoperative curarization and tracheal intubation when feasible could prevent the risk of ARF and emergent tracheal intubation during surgery, mainly due to the surgery itself, the anesthetic strategy (especially if it includes sedation or spinal/epidural anesthesia), and the position (e.g., supine decubitus in orthopnoic patients). As a consequence, when the risk of causing a permanent dependency from mechanical ventilation is considered too high, an otherwise indicated surgery can be denied by the surgeon or the anesthetist; similarly, the patient can refuse to undergo surgery when facing this risk.
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