Implications of Early Non-invasive CPAP Therapy on Postoperative Respiratory Outcomes in Morbidly Obese Patients after Bariatric Surgery: A Randomized Controlled Trial

Background: Morbid obesity in Egypt is linked to increased perioperative pulmonary risks. Despite bariatric surgery's efficacy, postoperative respiratory complications persist.
Objective: The aim of this work was to evaluate the effect of early noninvasive CPAP therapy on postoperative pulmonary functions and radiological atelectasis in 24 hours in morbidly obese patients after bariatric surgery.
Patients and Methods: In this randomized, single-blinded trial (at Sohag University Hospitals, July 2019–July 2022), 60 patients were assigned to receive either noninvasive CPAP ventilation (n = 30) for the first 6 hours then nasal oxygen for 24 hours post-extubation (CPAP group) or nasal oxygen (n = 30) for 24 hours post-extubation (Nasal group). Baseline and 24 hours postoperative pulmonary function tests (PFT) as; functional vital capacity (FVC), forced expiratory volume in first second FEV1 and FEV₁/FVC ratio, chest X-ray, and CT were done and analysed. Respiratory, non-respiratory complication and hospital stay duration were reported and compared between the studied groups.
Results: CPAP group had significantly improved FEV1, FVC, and FEV1/FVC (p < 0.05) and reduced atelectasis (chest X-ray: 46.67% vs. 90%; CT: 46.67% vs. 86.7%; p < 0.001) than Nasal group in the first 24 hours postoperatively. CPAP group also had higher SpO₂ (p < 0.05), fewer reintubations (6.67% vs. 26.67%; p = 0.001), and shorter hospital stays (86.67% vs. 60% discharged within 48 h; p = 0.003). No observed differences were found in non-respiratory complications.
Conclusions: Early noninvasive CPAP therapy in post-bariatric surgery enhances pulmonary recovery, reduces respiratory complications and shortens hospital stay; supporting its routine use in morbidly obese patients.