OBJECTIVE: We evaluated the potential benefit of continuous positive airway pressure (CPAP) to prevent postoperative pulmonary complications (PPCs), atelectasis, pneumonia, and intubation in patients undergoing major abdominal surgery. SUMMARY BACKGROUND DATA: PPCs are common during the postoperative period and may be associated with a high morbidity rate. Efficacy of CPAP to prevent PPCs occurrence is controversial. METHODS: Medical literature databases were searched for randomized controlled trials examining the use of CPAP versus standard therapy in patients undergoing abdominal surgery. The meta-analysis estimated the pooled risk ratio and the number needed to treat to benefit (NNTB) for PPCs, atelectasis, and pneumonia. RESULTS: The meta-analysis was carried out over 9 randomized controlled trials. Overall, CPAP significantly reduced the risk of (1) PPCs (risk ratio 0.66; 95% confidence interval (CI) 0.52 to 0.85) with a corresponding NNTB of 14.2 (95% CI 9.9 to 32.4); (2) atelectasis (risk ratio 0.75; 95% CI 0.58 to 0.97; NNTB 7.3; 95% CI 4.4 to 64.5); (3) pneumonia (risk ratio 0.33; 95% CI 0.14 to 0.75; NNTB 18.3; 95% CI 14.4 to 48.8). In all cases the variation in risk ratio attributable to heterogeneity was negligible, although there was some evidence of publication bias. CONCLUSIONS: This systematic review suggests that CPAP decreases the risk of PPCs, atelectasis, and pneumonia and supports its clinical use in patients undergoing abdominal surgery.
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