Preintubation feedback controlled machine delivered noninvasive ventilation versus human delivered traditional mask vent
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LETTER TO THE EDITOR
Preintubation feedback controlled machine delivered noninvasive ventilation versus human delivered traditional mask ventilation: is human performance inferior to machine? Habib Md Reazaul Karim1 · Dušanka Obradović2 · Antonio M. Esquinas3 Received: 22 August 2019 / Accepted: 22 September 2019 © Springer Nature B.V. 2019
To the editor We have read with great interest the article by Fogarty M et al., which shows the effectiveness of a noninvasive ventilatory device versus a manual option of ventilation before tracheal intubation [1]. We consider the clinical implications to be necessary, but there are a few other relevant aspects that need consideration for clinical application. Firstly, the information on whether the increased delivered volume observed by the authors also improved or optimized oxygenation and ventilation is lacking. It is crucial to know about the oximetry and capnometry as it indicates the ventilatory efficacy [2, 3] Similarly, the value of the current tidal volume observed must take into account the value of the leakages around the mask in both methods as it can influence the result [4, 5]. Furthermore, clinical monitoring in the postoperative phases and influence on a short-term outcome like pulmonary atelectasis and other related complication is welcome. Secondly, the authors’ have selected ASA-I to III, where the ASA classes depend on the comorbidities. However, it is not clear whether the patients enrolled in the two groups had similar comorbidities, for example, chronic obstructive pulmonary disease or cardiac diseases, that have a clinical influence on deciding the tidal volume as well as ventilatory effectiveness. Thirdly, the upper airway patency and Bi-level positive airway pressure settings relationships also need attention. The authors’ have used 20 cmH2O during inspiration with
1 s inspiratory time, and 8 c mH2O during exhalation. The expiratory positive airway pressure can affect the tidal volume delivered during NIV [6]. Furthermore, whether the 8 cmH2O during exhalation could be enough to avoid upper airway collapse during sedation in all patients is also disputable [7]. We believe that information on whether any airway adjuncts like airways were used, and if used, how many in which group needs elaboration. Lastly, we believe that it would be much better if the patients were randomized into the two groups, one group of patients manually ventilated and another ventilated by NIV before intubation. Future such studies will help us in better understanding. We again compliment the authors for their excellent work and welcome the authors’ clarifications on these points, which will help the professionals in taking a well-informed decision.
* Habib Md Reazaul Karim [email protected]
1. Fogarty M, Kuck K, Orr J, Sakata D. A comparison of controlled ventilation with a noninvasive ventilator versus traditional mask ventilation. J Clin Monit Comput. 2019. https://doi.org/10.1007/ s10877-019-00365-1. 2. Caputo ND, Oliver M, West JR, Hackett R, Sakles JC. Use
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