Table 1.

Contraindications to postoperative PAP [74].

Contraindications
-Agitated, uncooperative, or severely encephalopathic -Inability to protect the airway/excessive secretions or impending respiratory arrest -Signs of pneumothorax post laparoscopic abdominal surgery -Fixed upper airway obstruction or patients unable to tolerate the increased work of breathing (acute asthma, COPD) -Intracranial pressure > 20 mm Hg -Uncontrolled cardiac ischemia or arrhythmias or hemodynamic instability -Ongoing nausea/vomiting or hemoptysis or epistaxis -Severe facial deformities, for example, from reconstructive procedures or facial tumors -Facial burns -Esophageal surgery -Known or suspected tympanic membrane rupture or other middle ear pathology
Special Considerations:
-Comorbid neuromuscular disease * -Transsphenoidal surgery

* CPAP is not recommended due to increased breathing work on a weak diaphragm, while bilevel PAP devices without a backup respiratory rate can also fail. Advanced non-invasive ventilation modes that offer backup respiratory rates and enhance ventilation are beneficial, as they can aid rapid shallow breathing, improve gas exchange, allow respiratory muscle rest, and preserve respiratory muscle strength.