الفهرس 
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Abstract
Obesity continues to be a major public health problem in the United States and all over the world, with more than one-third of adults considered obese in 2009–2010(3).
Currently, bariatric surgery is the most effective therapy for sustained weight loss, decreased morbidity and mortality, and improved quality of life measures. Morbidly obese patients are at an increased risk for postoperative pulmonary complications such as atelectasis and upper airway obstruction due to obstructive sleep apnea syndrome (OSA), anesthesia, and opioid analgesia(4).
Noninvasive ventilation devices such as continuous positive airway pressure (CPAP) can be used to reduce the incidence of postoperative pulmonary complications in obese patients undergoing bariatric surgery. The maintenance of positive airway pressure immediately post extubation may result in a significant improvement in spirometric lung functions (5).
Hence, the aim of this study was to evaluate role of CPAP in morbidly obese patients after bariatric surgery within the first 24hs as regard postoperatively complications of respiratory system (hypoxia due to mainly atelectasis, aspiration, hypoventilation, pneumonia and re-intubation) and within the first 10 days post-operatively for cardiovascular system complications (arrhythmia, myocardial infarction and heart failure).
This prospective, comparative, single blind, and randomized study included 60 patients with BMI >40kg/m2 they were randomly allocated into: C group and O group; 30 patients in each. All patients were subjected to pre-operative and intraoperative evaluation, Also; postoperative care unit data was gathered included: NIV parameters, post-operatively cardiovascular system observation, post-operative respiratory system observation, post-operative gastro-intestinal tract observation, post-operative analgesia and pain score.
Summary of our results
There were no statistically significant differences between both groups as regard preoperative laboratory investigation (TSH, cortisol 9am, cortisol 9pm, HbA1c, ECG&Echo) and preoperative fitness
Pre-operative pulmonary functions tests (FEV1, FVC & FEV1/FVC), normal/atelectasis ratio by chest X ray and CT, oxygen saturation and tension which are the primary end points of our study showed no statistically differences between both groups.
24h Post-operatively (post-intervention) pulmonary functions (FEV1, FVC and FEV1/FVC) showed statistically significant increased at C group than O group, statistically significant increased at C group and statistically significant decreased at O group.
0h postoperatively normal/atelectasis ratios by X ray and CT chest were statistically insignificant between both groups.
0h postoperatively normal/atelectasis ratios by X ray and CT chest were statistically significant lower than preoperatively in both groups (effect of anesthesia).
24h post-operatively normal/atelectasis ratios were statistically significant higher at C group than O group.
In C group normal/atelectasis ratios were statistically significant higher at 24h post-operatively than 0h post-operatively and higher than pre-operatively.
In O group normal/atelectasis ratios were statistically insignificant different between 24h post-operative and 0h post-operatively but statistically significant lower at 24h post-operatively than pre-operatively.
Incidences of atelectasis pre-operative and 0h post-operative were statistically insignificant different between both groups.
Incidences of atelectasis 24h post-operative were statistically significant lower at C group than O group.
Incidences of atelectasis at C group were statistically significant lower at 24h postoperatively than pre-operatively& than 0h postoperatively.
Incidences of atelectasis at O group were statistically significant higher at 24h postoperatively than pre-operatively
Relative risk of using O2/CPAP= 6.15. Attributable risk of using O2=70%
Post-intervention SaO2 values were statistically significant higher at C group than O group at all time of the measurements, they were statistically insignificant different between both groups.
Post-intervention PaO2 (mmHg) values were statistically significant higher at C group than O group at all time of the measurements except at pre-operative and 0h postoperatively, they were statistically insignificant different between both groups.
Blood pH values were statistically significant improved at C group than O group at 6h, 8h, 10h, 12h and 24h post-operatively, and was statistically insignificant different between both groups at pre-operative,0h, 2h and 4h hours post-operatively. PCO2 values were statistically significant decreased at C group than O group at all time of the measurements except at pre-operative& 0h post-operatively it was statistically insignificant different between both groups.
HCO3 values were statistically significant lower at C group than O group at 4h, 6h, 10h, 24 h post-operatively and was statistically insignificant different at pre-operatively,0h,2h ,8h &12h post-operatively.
Respiratory rate (RR) (breath/min) values were statistically insignificant between both groups at all time of the measurements except 2h postoperatively, it was statistically significant decreased at C group than O group.
Heart rate (beat/min) values were statistically insignificant different between both groups at all times of measurements.
Mean arterial blood pressure (MAP) values were statistically insignificant different between both groups at all times of the measurements.
ECG abnormalities post-intervention values were statistically significant decreased at C group than O group at all time of the measure-ements (2h, 4h, 6h, 8h, 10h, 12h& 24h postoperatively) except at pre-operative&0h post-operative, they were statistically insignificant different between both groups.
Rrespiratory complications were statistically significant lower at C group than O group.
Cardiovascular complications were statistically insignificant different between both groups.
GIT complications (vomiting and abdominal distension) were statistically insignificant different between both groups.
Hospital stay days were statistically significant lower at C group than O group.
Pain score (Visual analogue scale VAS) &Analgesia requirements were statistically insignificant different between both groups.
Conclusion and Recommendations
Conclusion
Early initiation of short-term CPAP during the first 24h after sleeve gastrectomy operations promotes more rapid recovery of postoperative lung functions, oxygenation and atelectasis and this is a good effect of CPAP as we know that atelectasis actually worsens in patients who are morbidly obese over the first 24 postoperative hours. Morbid obese patients (with poor lung functions, lung atelectasis, obstructive‐apnea syndrome and obesity‐hypoventilation syndrome) should be investigated to introduce appropriate treatment, including implementation of positive airway pressure.
Limitations
It is a single-center study, conducted in a hospital with an obesity surgical treatment unit thus, our results may not be able to generalize other populations.
The majority of patients enrolled in this study were women, reflecting the demographics of bariatric surgery patients. It is possible that different outcomes would have been observed if more men, with characteristic central obesity, were enrolled in this study.
The study conducted in era of pandemic covid 19 which negatively affect our results in the form of more precautions, limitation of number of cases submitted to our study and ICU admission.
Recommendations
Larger future studies with multicenter cooperation are needed to verify our results.
The early application of CPAP during the first 24h postoperatively is recommended in morbid obese patients to improve oxygenation and decrease lung atelectasis.
NIV requires trained nurses and initial equipment expenses, and criteria for its prophylactic use in the immediate postoperative period are needed to be defined.
The continued use of CPAP in the postoperative period—in the hospital— result in decreasing short-term morbidity.