Intraoperative Nasal Positive Airway Pressure in High-Risk Obstructive Sleep Apnea Patients Undergoing Total Knee Arthroplasty.
•Patients with obstructive sleep apnea (OSA) face increased risk of perioperative pulmonary complications, including hypoventilation, hypoxemia, atelectasis, prolonged intubation, and extended hospital stay1.
•Nasal continuous positive airway pressure (NCPAP) relieves upper airway obstruction, prevents and treats atelectasis, and reduces incidence of acute respiratory failure2 (Figure 1).
•OSA has been associated with postoperative complications without perioperative NCPAP use3.
•CPAP is typically used postoperatively to treat airway obstruction, however, less is known about the potential benefits of intraoperative NCPAP use under spinal anesthesia and deep sedation.
•This study evaluated the effects of intraoperative NCPAP on patients who underwent total knee arthroplasty (TKA) with known or high- risk for OSA over the standard simple mask.
Hypothesis: Intraoperative NCPAP would be associated with more favorable outcomes than a similar cohort that used simple masks:
•(Primary) Fewer PACU desaturation episodes (O2<88%)
•Shorter time to pass room air trials
•Shorter PACU stays
•Fewer pulmonary complications
Population: 1516 patients diagnosed with or at high risk for OSA that underwent TKA between January 2020 and February 2024.
Ø386 (NCPAP group)
Ø1130 (Control group, simple mask)
Ethics Statement: This study was approved by the Institutional Review Board. Since the study involved only minimal risk to the participants, a total waiver of written informed consent was granted by the IRB.
Results:
•The NCPAP group had a higher body mass index (36.75 vs. 36.05, p=0.042) (Table 1).
•There was no difference in PACU desaturation events between the groups (4.6 vs 4.4%, p=0.872) (Table 2).
•The NCPAP group received more intraoperative sedation on average (4.05 vs 3.92, p=0.031) and took longer time to pass room air trial (54 vs 46 minutes, p =0.006) (Figure 2 A & B).
•The NCPAP had shorter time to care completion (59 vs 60 minutes, p=0.001) and PACU length of stay (84 vs 90 minutes, p<0.001) (Figure 2 C & D).
•Incidence of postoperative hypoxemia was greater among the NCPAP group (2.6 vs 1.2%, p=0.046, Table 3).
•The NCPAP had fewer hospital readmissions (1.3 vs 3.2%, p=0.048) (Table 2).
