ACA App
Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
Home | About us | Editorial Board | Search | Ahead of print | Current Issue | Archives | Submission | Subscribe | Advertise | Contact | Login 
Users online: 350 Small font size Default font size Increase font size Print this article Email this article Bookmark this page
 


 

 
     
    Advanced search
 

 
 
     
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed77    
    Printed2    
    Emailed0    
    PDF Downloaded7    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents
LETTERS TO EDITOR  
Year : 2020  |  Volume : 23  |  Issue : 3  |  Page : 373-374
In response to letter title “Immediate hemodynamic and gaseous exchange effect of bi-level positive airway pressure after cardiac surgery: Our insight to Hamid et al.'s study”


Department of Anaesthesia, Aga Khan University, Karachi, Pakistan

Click here for correspondence address and email

Date of Submission27-Mar-2020
Date of Acceptance09-May-2020
Date of Web Publication17-Jul-2020
 

How to cite this article:
Hamid M, Akhtar MI, Ahmed S. In response to letter title “Immediate hemodynamic and gaseous exchange effect of bi-level positive airway pressure after cardiac surgery: Our insight to Hamid et al.'s study”. Ann Card Anaesth 2020;23:373-4

How to cite this URL:
Hamid M, Akhtar MI, Ahmed S. In response to letter title “Immediate hemodynamic and gaseous exchange effect of bi-level positive airway pressure after cardiac surgery: Our insight to Hamid et al.'s study”. Ann Card Anaesth [serial online] 2020 [cited 2020 Aug 12];23:373-4. Available from: http://www.annals.in/text.asp?2020/23/3/373/290055




The Editor,

Thank you for the opportunity to respond to the letter by Karim et al.,[1] in reference to our study.[2] The authors in this letter have expressed few concerns regarding our study and I would like to respond in the same sequence.

First critique is that we only used Bilevel Positive Airway Pressure (BiPAP) in nonhypercapnoeic patients. It is erroneous, as we also included hypercapoeic patients. In our study eight patients had PaCO2 50 mm Hg or greater. The mean value of 44 mm Hg in pre-BiPAP period probably gives a false impression that these patients were excluded.

About echocardiographic evaluation of cardiac function before and after applying a BiPAP, I think it is difficult as you know that once you decide about BiPAP application it should be done quickly to prevent decompensation. I was unable to find any study where ECHO was used in such situation. It is a good idea but may be impractical in this scenario. Hoffman et al.[3] also used PA catheter readings for cardiac index and cardiac output rather than relying on echocardiography. Their study showed improved cardiac function after BiPAP and this effect was also present in our study. Another question regarding pulmonary HTN, we did not find pulmonary HTN in preoperative evaluation and second it would have made no difference as we compared the pre and post BiPAP hemodynamics.

Second, about comorbidities such as COPD and sleep apnea, we were unable to find COPD and sleep apnea complaints during preoperative evaluation. These questions were asked specifically and past medical record was checked for these conditions.

Regarding pain and sedative medications influencing parameters. During the short study period, no one was given sedatives or pain medications so I do not think it is an issue here. Generally, we avoid sedatives in all postoperative patients and even analgesics, which we use have minimal effect.

About the effect of BiPAP on reintubation rate, there are several studies mentioned that BiPAP application reduces reintubation rate in respiratory failure patients.[4],[5] I agree with the authors that the prophylactic use of BiPAP is controversial. They mentioned Aǧıroǧlu G et al.[6] study where BiPAP was used prophylactically in nonrespiratory distress patients. It was used twice for 20 min with 3 h interval while we used different criteria for included patients and duration of application was different as well. We firmly believe that BiPAP application does help the patient in respiratory distress after cardiac surgery and reduces reintubation rate.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Karim HMR, Gonçalves G, Esquinas AM. Immediate hemodynamic and gaseous exchange effect of Bi-level positive airway pressure after cardiac surgery: Our insight to Hamid et al.'s study. Ann Card Anaesth 2020;23:372.  Back to cited text no. 1
    
2.
Hamid M, Akhtar MI, Ahmed S. Immediate changes in hemodynamics and gas exchange after initiation of noninvasive ventilation in cardiac surgical patients. Ann Card Anaesth 2020;23:59-64.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Hoffmann B, Jepsen M, Hachenberg T, Huth C, Welte T. Cardiopulmonary effects of non-invasive positive pressure ventilation (NPPV)--A controlled, prospective study. Thorac Cardiovasc Surg 2003;51:142-6.  Back to cited text no. 3
    
4.
Liu YJ, Zhao J, Tang H. Non-invasive ventilation in acute respiratory failure: A meta-analysis. Clin Med (Lond) 2016;16:514-23.  Back to cited text no. 4
    
5.
Olper L, Corbetta D, Cabrini L, Landoni G, Zangrillo A. Effects of non-invasive ventilation on reintubation rate: A systematic review and meta-analysis of randomised studies of patients undergoing cardiothoracic surgery. Crit Care Resusc 2013;15:220-7.  Back to cited text no. 5
    
6.
Aǧıroǧlu G, Baysal A, Copuroǧlu E, Gül Y, Karamustafaoǧlu Y, Dogukan M. Does early use of Bilevel Positive Airway Pressure (BiPAP) in cardiothoracic intensive care unit prevent reintubation? Int J Clin Exp Med 2014;7:3439-46. eCollection 2014.  Back to cited text no. 6
    

Top
Correspondence Address:
Mohammad Hamid
Associate Professor, Department of Anaesthesia, Second Floor PW II, Aga Khan University, Stadium Road, Karachi, Sindh
Pakistan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_57_20

Rights and Permissions




 

Top