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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-10071-24776
Letter to the Editor
Author Response: Oxygen Delivery Devices in Postoperative Patients: Proper Selection of Patients Matters!
Mishra Susri 1https://orcid.org/0009-0002-4550-5849

Kothari Nikhil 2https://orcid.org/0000-0002-9829-905X

Sharma Ankur 3https://orcid.org/0000-0001-9339-6988

Goyal Shilpa 4https://orcid.org/0000-0002-8983-0953

1,2,4 Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
3 Department of Trauma and Emergency (Anesthesia & Critical Care), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
Ankur Sharma, Department of Trauma and Emergency (Anesthesia & Critical Care), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, Phone: +91 9654045653, e-mail: ankuranaesthesia@gmail.com
8 2024
31 7 2024
28 8 803803
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: Mishra S, Kothari N, Sharma A, Goyal S. Author Response: Oxygen Delivery Devices in Postoperative Patients: Proper Selection of Patients Matters! Indian J Crit Care Med 2024;28(8):803.

Keywords

Hypoxemia
Oxygenation
Ratio of partial pressure of oxygen in arterial blood (PaO2) and fraction of inspired oxygen (FiO2)
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pmcDear Editor,

We thank Dr Bhattacharya et al. for their enlightening remarks and interest in our research.1

In our study, the choice of oxygen delivery vehicle (ODV) was random using the sealed envelope method. The low mean partial pressure of oxygen (PaO2) in the noninvasive ventilation (NIV) group is purely incidental. The difference between the mean values of the groups was analyzed using the analysis of variance (ANOVA) test, which showed a p-value of 0.994 (after ODV), which was statistically nonsignificant.2

We agree that the risk of postoperative hypoxemia is higher with surgeries involving incision closure to the diaphragm. Considering that concern, we excluded patients with post-thoracotomy and lung surgeries from our study. Although in this open-labeled randomized trial, the distribution of aged patients was incidentally higher in the NIV group than the venturi mask group, the overall age distribution was comparable among the three groups (p = 0.214).

Instead of assessing pain through the visual analogue scale (VAS) score, we analyzed the patient's compliance with the ODV and ease of communication by COMFORT score.1 Lower scores indicated more comfort and better communication. Hence, the sedative effect of narcotic analgesics, leading to reduced ventilatory effort, can be overruled. We have also mentioned in the limitations that the evaluation of the patient's discomfort was based on subjective measures.

We excluded patients with associated comorbidities like chronic obstructive pulmonary disease (COPD) or any other restrictive lung diseases that increase the chances of postoperative pulmonary complications. Such patients were not included in our trial to avoid any adverse outcomes.

As the study was an open-labeled and unmasked trial, selection bias and performance bias were mitigated by using a sealed envelope method of randomization with minimal predictability.3,4

Orcid

Susri Mishra https://orcid.org/0009-0002-4550-5849

Nikhil Kothari https://orcid.org/0000-0002-9829-905X

Ankur Sharma https://orcid.org/0000-0001-9339-6988

Shilpa Goyal https://orcid.org/0000-0002-8983-0953

Source of support: Nil

Conflict of interest: None
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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. Mishra P Singh U Pandey CM Mishra P Pandey G Application of student's t-test, analysis of variance, and covariance Ann Card Anaesth 2019 22 4 407 411 10.4103/aca.ACA_94_19 31621677
3. Higgins KM Levin G Busch R Considerations for open-label randomized clinical trials: Design, conduct, and analysis Clin Trials 2024 17407745241244788 10.1177/17407745241244788 38618711
4. Mishra S Kothari N Sharma A Goyal S Rathod DK Meshram T et al. Author response: Beyond the nasal prongs: A Joust of oxygen delivery methods in post-op hypoxemia Indian J Crit Care Med 2024 28 6 626 627 10.5005/jp-journals-10071-24740 39130382
