To the Editor: In their study of the effect of continuous positive airway pressure (CPAP) on postoperative hypoxemia,1 Dr Squadrone and colleagues found a higher rate of surgical site infection or anastomotic leak in the control group. Reduction in atelectasis by positive end-expiratory pressure, which has been shown to decrease bacterial growth in the lung2 and thereby may decrease bacteremia in the presence of established pulmonary infection,3 does not necessarily explain this finding. Another possibility is that with less atelectasis there is a reduction in systemic inflammation and less circulating immunomodulatory mediators. It would therefore be interesting to know whether the authors measured group differences between serum cytokines or trends in protein level or total body water that might correlate with tissue integrity and healing. If the level of inflammation or mediator release were similar between groups, the difference in the rates of anastomotic leaks may have been due to chance.
Additionally, we believe that the results of this study should be applied with caution in settings that do not have access to a similar helmet, which appears to minimize gastric distention.4 Fewer than 25% of the patients in the study had upper gastrointestinal tract anastomoses performed, so until there is more definitive evidence that immediate postoperative CPAP is safe following upper gastrointestinal tract surgery, CPAP should not be advocated in these patients.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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