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Letters |

Treatment of Postoperative Respiratory Failure

Waheedullah Karzai, MD; Egbert Hüttemann, MD
[+] Author Affiliations

Phil B. Fontanarosa, MDDeputy Editor: IndividualAuthor
Stephen J. Lurie, MD, PhDContributing Editor: IndividualAuthor

Copyright 2000 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

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JAMA. 2000;283(17):2239-2240. doi:10-1001/pubs.JAMA-ISSN-0098-7484-283-17-jlt0503
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To the Editor: Dr Antonelli and colleagues1 report that in patients with acute respiratory failure following solid organ transplantation, noninvasive ventilation (NIV) compared with standard care reduces rates of endotracheal intubation, length of stay in the intensive care unit (ICU), rates of fatal complications, and ICU mortality. In the study, standard care consisted of oxygen supplementation with a Venturi mask. We believe, however, that in patients with postoperative respiratory failure, mere supplementation with oxygen is not adequate care. Especially after major surgery, standard care in patients with respiratory failure also should include lung expansion maneuvers, such as application of continuous positive airway pressure (CPAP) and deep-breathing exercises.2 Thus, this study might be interpreted as showing that inadequate care of patients with respiratory failure is harmful.

In our hospital ICU, CPAP is usually applied to patients postoperatively every 4 or 6 hours for 30- to 60-minute intervals or continuously over several hours. CPAP is simple to apply and is effective in treating atelectasis and improving oxygenation in patients with respiratory failure.3

REFERENCES

Antonelli  M, Conti  G, Bufi  M.  et al.  Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA. 2000;283:235-241.
Smetana  GW. Current concepts: preoperative pulmonary evaluation. N Engl J Med. 1999;340:937-944.
Branson  RD, Hurst  JM, DeHaven Jr  CB. Mask CPAP: state of the art. Respir Care. 1985;30:846-857.

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Antonelli  M, Conti  G, Bufi  M.  et al.  Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA. 2000;283:235-241.
Smetana  GW. Current concepts: preoperative pulmonary evaluation. N Engl J Med. 1999;340:937-944.
Branson  RD, Hurst  JM, DeHaven Jr  CB. Mask CPAP: state of the art. Respir Care. 1985;30:846-857.
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To understand the clinical management of acute heart failure syndromes.
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