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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-10071-24729
Letter to the Editor
Oxygen Delivery Devices in Postoperative Patients: Proper Selection of Patients Matters!
Bhattacharya Dipasri 1https://orcid.org/0000-0002-9001-1525

Esquinas Antonio M 2https://orcid.org/0000-0003-0571-2050

Mandal Mohanchandra 3https://orcid.org/0000-0003-4183-993X

1 Department of Anaesthesiology, Pain Medicine and Critical Care, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
2 Department of Intensive Care Unit, Hospital Morales, Meseguer, Murcia, Spain
3 Department of Anaesthesiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
Mohanchandra Mandal, Department of Anaesthesiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India, Phone: +91 9433072820, e-mail: drmcmandal@gmail.com
8 2024
31 7 2024
28 8 802802
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: Bhattacharya D, Esquinas AM, Mandal M. Oxygen Delivery Devices in Postoperative Patients: Proper Selection of Patients Matters! Indian J Crit Care Med 2024;28(8):802.

Keywords

Chronic obstructive pulmonary diseases
Functional residual capacity
High-flow nasal cannula
Noninvasive ventilation
Venturi mask
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pmc Dear Editor,

We have read the study of Mishra, et al. with great interest.1 While they had observed none of the devices proved superior in their efficacy, certain points need further clarification in better understanding of their valuable observed data.

First, although post-application partial pressure of oxygen in arterial blood (PaO2) in all three groups are comparable, a considerably low value of baseline PaO2 in the noninvasive ventilation (NIV) group translates into a greater magnitude of changes. Thus, it warrants a re-look into their displayed data that could really reveal any discernible effect of NIV compared with others.

Second, the author did not mention the type and site of surgery as the chance of postoperative hypoxemia is high in major surgery involving incision closure to the diaphragm. The study included a wide range of age-groups from 18 to 65 years. The reduction of functional residual capacity (FRC) and increase in closing capacity and their relation changes at around 44 years.2 Hence, a patient aged 65 years behaves in a different way than younger patients after surgery in view of postoperative hypoxemic events. The distribution of aged patients (>50 years) was considerably higher in the NIV group than in the venture mask group (53 vs 30%, respectively). It would be prudent to identify the high-risk patients where postoperative oxygen therapy should be initiated to reduce these pulmonary adverse events.3

Third, we are curious to know how the author assessed pain, the mean VAS score, and pain medications used in the postoperative period. Postoperative pain can lead to shallow breathing resulting in hypoxemia owing to shallow breathing.3 On the other hand, the effect of sedative effect of narcotic analgesics contributing to reduced ventilator effort cannot be overruled.

Fourth, it would be further interesting to know the group-wise distribution of associated comorbidities, especially chronic obstructive pulmonary diseases (COPD) or any restrictive lung diseases that increase the chances of postoperative pulmonary complications (PPC). High-flow nasal cannula (HFNC) has the potential to improve thoracoabdominal asynchrony and may be beneficial in conditions where poor respiratory mechanics are contributing to acute respiratory failure.4

Although there was no superiority achieved by any of the devices over the other regarding postoperative hypoxemia, a better comfort score with HFNC and venture mask over NIV can yield reduced escalation of respiratory support.5

Last but not least, it is not clear from the description how the authors addressed the issues of performance bias as it was an open-labeled study. Further observation addressing the issues would yield other information.

Orcid

Dipasri Bhattacharya https://orcid.org/0000-0002-9001-1525

Antonio M Esquinas https://orcid.org/0000-0003-0571-2050

Mohanchandra Mandal https://orcid.org/0000-0003-4183-993X

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. Garland A Hopton P Airway closure in anaesthesia and intensive care BJA Educ 2022 22 4 126 130 10.1016/j.bjae.2021.12.001 35531076
3. Andualem AA Yesuf KA Incidence and associated factors of postoperative hypoxemia among adult elective surgical patients at Dessie comprehensive specialized hospital: An observational study Ann Med Surg (Lond) 2022 78 103747 10.1016/j.amsu.2022.103747 35734654
4. Lee CC Mankodi D Shaharyar S Ravindranathan S Danckers M Herscovici P et al. High flow nasal cannula versus conventional oxygen therapy and non-invasive ventilation in adults with acute hypoxemic respiratory failure: A systematic review Respir Med 2016 121 100 108 10.1016/j.rmed.2016.11.004 27888983
5. Zhao H Wang H Sun F Lyu S An Y High-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy but not to noninvasive mechanical ventilation on intubation rate: A systematic review and meta-analysis Crit Care 2017 21 1 184 10.1186/s13054-017-1760-8 28701227
