Year : 2020  |  Volume : 23  |  Issue : 3  |  Page : 372-

Immediate hemodynamic and gaseous exchange; effect of Bi-Level positive airway pressure after cardiac surgery: Our insight to Hamid et al.'s study


Habib M R Karim1, Gil Gonçalves2, Antonio M Esquinas3,  
1 Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
2 Department of Pulmonology, Coimbra Hospital and University Centre, Coimbra, Portugal
3 Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain

Correspondence Address:
Habib M R Karim
Faculty Room A001, Block A. All India Institute of Medical Sciences, Raipur - 492 099, Chhattisgarh
India




How to cite this article:
R Karim HM, 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;23:372-372


How to cite this URL:
R Karim HM, 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 [serial online] 2020 [cited 2020 Nov 30 ];23:372-372
Available from: https://www.annals.in/text.asp?2020/23/3/372/290052


Full Text



The Editor,

Cardiopulmonary dysfunction is a very critical aspect that needs consideration in postoperative cardiac surgical patients. We read with great interest this article about hemodynamic and gaseous exchange effects of BiLevel positive airway pressure (BiPAP) in post-cardiac surgery.[1] This is an exciting yet controversial topic, with significant relationships with postoperative complications such as cardiac failure and others. In this study, the authors focus on cardiovascular parameters. We feel that a few aspects of the study need more information for better acceptance of the result.

First, the authors use this ventilator mode in non-hypercapnic patients, which may influence interpretation.[2] Also, echocardiographic evaluation and cardiac function correlations, if done, will provide us with better insight. It is known that the hemodynamic response is related to cardiac function and pulmonary hypertension. These are two main factors that are correlated with BiPAP, which authors need to take into account.

Second, it is vital to know the comorbidities, especially chronic obstructive pulmonary disease in patients enrolled.[3] Eight (24.2%) patients were obese and the majority were male in the study. We are not aware of the obstructive sleep apnea status of the patients. As these patients are likely to require different (higher) BiPAP settings, it is critical to know whether the authors have used different pressures or not. This aspect is essential to understand the results.

Third, pain and sedation are important aspects that can affect hemodynamics and pulmonary function (gaseous exchange) in postoperative patients.[4] Further, the authors consider that the BiPAP application was also able to decrease the need for reintubation in post-cardiac surgery; however, this topic is controversial.[5] In this aspect, the readers will get benefitted from the re-intubation criteria, pain, and sedation related management and data. Thanking you and the authors

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Hamid 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.
2Avidan MS, Ali SZ, Tymkew H, Jacobsohn E, De Wet CJ, Hill LL, et al. Mild hypercapnia after uncomplicated heart surgery is not associated with hemodynamic compromise. J Cardiothorac Vasc Anesth 2007;21:371-4.
3Burns KE, Meade MO, Premji A, Adhikari NK. Noninvasive positive-pressure ventilation as a weaning strategy for intubated adults with respiratory failure. Cochrane Database Syst Rev 2013;CD004127.
4Sasseron AB, Figueiredo LC, Trova K, Cardoso AL, Lima NM, Olmos SC, et al. Does the pain disturb the respiratory function after open heart surgery? Rev Bras Cir Cardiovasc 2009;24:490-6.
5Aǧıroǧlu 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.