
==== Front
Indian J Crit Care Med
Indian J Crit Care Med
IJCCM
Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine
0972-5229
1998-359X
Jaypee Brothers Medical Publishers

10.5005/jp-journals-10071-24720
Letter to the Editor
Beyond the Nasal Prongs: A Joust of Oxygen Delivery Methods in Post-op Hypoxemia
Gangireddy Sathwik 1https://orcid.org/0009-0001-7983-4272

Jindal Atul 2https://orcid.org/0000-0002-0504-1077

1,2 Department of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
Atul Jindal, Department of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India, Phone: +91 8224014667, e-mail: dratuljindal@gmail.com
6 2024
31 5 2024
28 6 625625
Copyright © 2024; The Author(s).
2024
https://creativecommons.org/licenses/by-nc/4.0/ © The Author(s). 2024 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
How to cite this article: Gangireddy S, Jindal A. Beyond the Nasal Prongs: A Joust of Oxygen Delivery Methods in Post-op Hypoxemia. Indian J Crit Care Med 2024;28(6):625.

Keywords

Hypoxemia
Mode of oxygen delivery
Postoperative care
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pmc Dear Editor,

We read the article written by Mishra et al.1 on the comparison of oxygen delivery devices in managing postoperative hypoxemia in adults recently published in IJCCM. Authors must be commended for carrying out a 3-pronged randomized trial in a busy setting of a postoperative care unit and the study has good statistical rigor as ANOVA and Chi-square tests were used to analyze data.

Postoperative adult patients aged 18–65 years were selected for the study. The selection criterion was hypoxia rather than hypoxemia as the title suggests. Though hypoxemia is the common cause of hypoxia, nonetheless in postoperative patients’ other causes like anemia play a part too. However, the selection was skewed though randomization was carried out: Non-invasive ventilation (NIV) group had significantly lower SpO2 and PaO2 in comparison with the other 2 groups. Instead of simple randomization, block or stratified randomization using covariates could have been done.

The study compares high-flow nasal cannula (HFNC) with venturi mask (VM) and NIV. Each has its own merits and demerits, but the choice of device depends on a multitude of factors: Pathophysiology behind hypoxemia (pulmonary edema, atelectasis, pleural effusion, upper airway obstruction, etc.), the neurological status of patient (influence of sedatives, neuromuscular blockers), comfort, etc. So, a blanket comparison of these devices is not valid in clinical practice. For example, in a study quoted in article, after cardiothoracic surgery, BiPAP fared well compared to HFNC because of afterload support that positive pressure provides, but this cannot be generalized: HFNC fares well in case of postoperative airway edema.2,3

The rationale behind the primary outcome, the change in PaO2/FiO2 ratio after 2 hours of oxygen use is not clear. The short-term effects of the delivery device may not truly reflect the long-term effectiveness and again depending on pathophysiology, though any form of oxygen flow initially may improve oxygenation transiently, unless the underlying mechanism of hypoxemia is not tackled hypoxemia will persist. Also, the settings of these delivery systems were not patient-tailored. Assessing patient comfort by keeping nil per oral for the 2 hours of study period does not reflect the comfort of the delivery device.

Longer duration of intervention and follow-up, patient-tailored management, and objective comfort measures can be further explored and built upon this study.

Orcid

Sathwik Gangireddy https://orcid.org/0009-0001-7983-4272

Atul Jindal https://orcid.org/0000-0002-0504-1077

Source of support: Nil

Conflict of interest: None
==== Refs
References

1. Mishra S Kothari N Sharma A Goyal S Rathod D Meshram T et al. Comparison of oxygen delivery devices in postoperative patients with hypoxemia: An open-labeled randomized controlled study Indian J Crit Care Med 2024 28 3 294 298 10.5005/jp-journals-10071-24659 38477006
2. Stéphan F Barrucand B Petit P Rézaiguia-Delclaux S Médard A Delannoy B et al. High-flow nasal oxygen vs noninvasive positive airway pressure in hypoxemic patients after cardiothoracic surgery: A randomized clinical trial JAMA 2015 313 23 2331 2339 10.1001/jama.2015.5213 25980660
3. Chaudhuri D Granton D Wang DX Burns KEA Helviz Y Einav S et al. High-flow nasal cannula in the immediate postoperative period: A systematic review and meta-analysis Chest 2020 158 5 1934 1946 10.1016/j.chest.2020.06.038 32615190
