Routine use of prophylactic postoperative continuous positive airway pressure (CPAP) should not be recommended because it was not effective at reducing pneumonia, endotracheal reintubation, or mortality, according to results of an open-label, randomized, phase 3 trial published in Lancet Respiratory Medicine.

Patients (N=4806) undergoing elective major intraperitoneal surgery at 70 hospitals in Italy, Norway, South Africa, Spain, Sweden, and the United Kingdom between 2016 and 2019 were recruited for the PRISM trial. The patients were randomly assigned in a 1:1 ratio to receive CPAP or usual care.

Patients in the intervention and control cohorts had a mean age of 67.8 (SD, 9.2) and 67.9 (SD, 9.2) years and 53.8% and 53.3% were men, respectively.


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The average duration of CPAP was 194.2 (SD, 97.4) minutes, and it was administered a median of 90 (interquartile range [IQR], 45-165) minutes after surgery. CPAP was delivered via facemask (69.8%), hood device (25.3%), nasal mask (1.2%), or unknown method (3.6%).

At 30 days, CPAP did not significantly reduce the rate of the composite outcome of pneumonia, endotracheal reintubation, or mortality (adjusted odds ratio [aOR], 1.01; 95% CI, 0.81-1.24; P =.95).

The median duration of the primary hospital stay was 9 (IQR, 6-13) and 8 (IQR, 6-13) days, and 9.5% and 10.1% of patients were readmitted to the hospital. Transfer to the intensive care unit (ICU) was required by 63.7% and 60.5%, and median stay in the ICU was 2 (IQR, 2-3) and 2 (IQR, 2-4) days for the CPAP and control cohorts, respectively.

Some patients in the CPAP cohort (8.9%) had adverse events. The most frequently reported events included claustrophobia (3.5%), oronasal dryness (1.9%), excessive air leak (1.9%), vomiting (1.2%), and pain (1.1%).

This study may have been limited by allowing clinicians to choose CPAP modalities.

This trial did not identify any benefit of administering CPAP therapy among patients 50 years and older undergoing elective major intraperitoneal surgery and should not be recommended.

Disclosure: This research was supported by Intersurgical. Please see the original reference for a full list of disclosures.

Reference

PRISM trial group. Postoperative continuous positive airway pressure to prevent pneumonia, re-intubation, and death after major abdominal surgery (PRISM): a multicentre, open-label, randomised, phase 3 trial. Lancet Respir Med. Published online June 18, 2021. doi:10.1016/S2213-2600(21)00089-8