Non-invasive positive pressure ventilation in the immediate post-bariatric surgery care of patients with obstructive sleep apnea: A systematic review

Abstract Background Obstructive sleep apnea is common in morbidly obese patients and non-invasive positive pressure ventilation (NIPPV) is the standard treatment. Post-operatively NIPPV is highly effective in preventing hypoxia and apneic episodes, however a concern of gastric distention leading to increased risk of an anastomotic dehiscence limits universal acceptance. Objective To perform a systematic review of the literature to determine if the use of NIPPV during immediate post-bariatric surgery care is safe. Methods Between January 1, 2000 and January 1, 2015 a comprehensive literature search for English-language articles was performed. Search terms were related to NIPPV use and bariatric surgery. Three reviewers independently reviewed the full text version of the articles for relevance. Due to lack of randomized controlled trials and common incidence of zero for leak rate, a meta-analysis was not conducted. Results A total of 824 studies were identified for screening using our search criteria and 811 were rejected based on exclusion criteria. Thirteen studies with 5465 patients were identified for abstract review. All articles were either favorable or equivocal in the use of NIPPV in this patient population. Comparative studies did not identify an increased rate of anastomotic dehiscence in the patients that did receive NIPPV. The use of NIPPV was associated with a decreased risk of respiratory complications but not of reintubation or unplanned intensive care unit admission. Conclusion This systematic review of the available literature does not provide evidence of a signal that there is an increased anastomotic dehiscence risk when NIPPV is administered during immediate post-bariatric surgery care.