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Continuous Positive Airway Pressure and Postoperative Hypoxemia—Reply
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In Reply: We agree with Drs Frangos and Schwartz that CPAP-induced recruitment of atelectasis may attenuate the spillover of inflammatory mediators from the lung to the systemic circulation1 and may have contributed to the reduction in sepsis and anastomotic leakage that we observed in the patients treated with CPAP. Unfortunately, we did not prospectively measure inflammatory mediators, protein concentration, or total body water. Further studies are required to explain the role of CPAP in preventing postoperative sepsis and anastomotic leakage.
Drs Frangos and Schwartz also suggest that if surgical procedures require upper gastrointestinal tract anastomoses, CPAP should not be used because of the possible consequences of gastric distension. Upper esophageal sphincter pressure in humans ranges between 10 and 50 cm of H2O, and significant increases in upper esophageal sphincter pressure occur with inspiration in order to exclude air from the esophagus.2 Under these circumstances, the levels of CPAP used . . . [Full Text of this Article]
V. Marco Ranieri, MD
marco.ranieri@unito.it
Vincenzo Squadrone, MD
Dipartimento di Anestesiologia e Rianimazione
Azienda Ospedaliera S. Giovanni Battista-Molinette
Università di Torino
Torino, Italy
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