Physiotherapist-led intermittent noninvasive ventilation for hypoxaemia following abdominal surgery in a quaternary Australian hospital: a randomised pilot feasibility trial

Background Physiotherapy management of postoperative hypoxaemia is understudied. This trial aimed to assess the feasibility of a trial of physiotherapist-led noninvasive ventilation (NIV) in adults with hypoxaemia following major abdominal surgery. Methods This prospective, single-centre, parallel-group, assessor-blinded, feasibility pilot trial with concealed allocation and intention-to-treat analysis randomised adults with hypoxaemia (oxyhaemoglobin saturations <90% on room air) within 72 h of major abdominal surgery to either usual care physiotherapy (education, early mobilisation, and deep breathing and coughing exercises), or usual care plus four 30-min sessions of physiotherapist-led NIV. The primary outcome was feasibility, including patient recruitment rates, NIV treatment adherence, and acceptability to patients. Exploratory outcomes included postoperative pulmonary complications (PPCs). Results From 50 participants, 49 were analysed. Mean age (standard deviation) was 62 (10) yr and 51% were male. Over 30 weeks, the recruitment rate was 1.7 participants per week (95% confidence interval [CI], 0.7–3.4). Mean total NIV delivered was 78 min (95% CI, 55–100) of the protocolised 120 min. There were no serious adverse events. NIV was acceptable to 91% of participants (20/22; 95% CI, 72%–97%). The PPC incidence on trial enrolment ranged from 6% (3/49; 95% CI, 2%–17%) to 47% (23/49; 95% CI, 34%–61%) depending on the measurement tool used. Conclusions Recruitment to this trial of physiotherapist-led NIV in patients with postoperative hypoxaemia was feasible. NIV was rated acceptable by most participants, and NIV adherence similar to that of previous trials. This study provides valuable insights for the design and conduct of future physiotherapy postoperative treatment studies. Clinical trial registration ACTRN12622000839707. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382199&isReview=tru