Prophylactic C-Pap versus Oxygen Support with Venturi Mask in COPD Patients Undergoing Lung Lobectomy: A Pilot StudyElisabetta Gualtieri, Md1; Adducci, Enrica; Md, ; Primieri, Paolo; Md, ; Galla, Amerigo; Md, ; Chiappetta, Marco; Md, ; Granone, Perluigi; 1Università Cattolica del Sacro Cuore, Md1.; Roma, ; Italy, ; 2ieo, ; Milano

Objective: Evaluating the feasibility and the efficacy of prophylactic post-operative Continuous Positive Air Pressure (C-PAP) administration in a thoracic surgery unit, compared to oxygen support with Venturi mask in term of Oxygen Partial Pressure/Oxygen concentration in breathed air (PaO2/FiO2) in COPD patients undergoing lung lobectomy. Materials and Methods: Respiratory morbidity after lung resection may occur in 15-20% of the patients, and C-PAP is an effective therapy. It is usually administered in Intensive Care Unit (ICU), while its prophylactic use is not well investigated and it isn't reported in a thoracic ward. We enrolled 19 patients with stage II COPD according GOLD score underwent lung lobectomy in a prospective randomized trial. Group A (10 patients) received in post-operative (PO) a FiO2 percentage to obtain a saturation > 95% with a Venturi mask, while group B (9 patients) received in PO a prophylactic C-PAP to obtain a saturation > 95% with a facial mask and 7,5 mmHg valve for two hours after surgery and then 2 hours every 8 hours for the first and the second post-operative day. PaO2 evaluation was made during the treatment 2 hours after surgery (T1) and in the first PO day (T2) and in FiO2 21% in the second PO day(T3). The two groups received the same treatment in terms of surgical access and resection (lateral thoracotomy and lobectomy), general anesthesia , PO physiotherapy and analgesic therapy. Results: No differences in terms of general characteristics, comorbidities, respiratory function (FEV1, FVC, DLCO, PaO2/FiO2), heart rate, blood pressure, and surgery time were noted between the two groups. PaO2/FiO2 was 379,5 ± 26,7 vs 415,3 ± 102,2 at T1 (p= 0,6), 357 ± 105 vs 310 ± 127 at T2 (p=0,4) and 323,5 ± 62,9 vs 315,2 ± 33,1 at T3 (p=0,4). We documented respiratory complications in 4 patients in the group A and in 3 patients in the group B. In group A one patients had acute pulmonary oedema needed orotracheal intubation and ICU transfer in first PO day, while the other three patients showed desaturation < 70 % during the first PO day. Three patients in group B had the x-ray chest showed microatelectasis in first post-operative day with resolution the next day. In particular PaO2/FiO2 in complicated patients in group A and in group B was 195 ± 38,5 vs 435,2 ± 129,8 (p=0,019) at T1; 166,3 ± 33 vs 371,3 ± 166,9 at T2 (p=0,022) and 253 ± 33,4 vs 313,6 ± 33,6 at T3 (p= 0,07) respectively. Finally, there were not differences between the two groups in term of prolonged air leak (0 patients in group A and B both), hospital stay and satisfaction about the treatment. Conclusion: Our initial findings show the feasibility of a C-PAP prophylactic program in a thoracic surgery unit and suggest the C-PAP prophylactic role to avoid desaturation and pulmonary oedema and the C-PAP curative role in atelectasis after lung lobectomy in COPD patients, as is notable in a significantly better PaO2/FiO2 in group B complicated patients than in group A complicated patients. We studied 19 patients with stage II COPD according GOLD score undergoing lung lobectomy. Our initial findings show the C-PAP prophylactic role to avoid desaturation and pulmonary oedema and the C-PAP curative role in atelectasis after lung lobectomy in COPD patients a significantly better PaO2/FiO2 in group B complicated patients than in group A complicated patients