Author Response: Oxygen Delivery Devices in Postoperative Patients: Proper Selection of Patients Matters!

Susri Mishra¹https://orcid.org/0009-0002-4550-5849, Nikhil Kothari²https://orcid.org/0000-0002-9829-905X, Ankur Sharma³https://orcid.org/0000-0001-9339-6988, Shilpa Goyal⁴https://orcid.org/0000-0002-8983-0953

^1,2,4Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

³Department of Trauma and Emergency (Anesthesia & Critical Care), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Corresponding Author: Ankur Sharma, Department of Trauma and Emergency (Anesthesia & Critical Care), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India, Phone: +91 9654045653, e-mail: ankuranaesthesia@gmail.com

How to cite this article: Mishra S, Kothari N, Sharma A, Goyal S. Author Response: Oxygen Delivery Devices in Postoperative Patients: Proper Selection of Patients Matters! Indian J Crit Care Med 2024;28(8):803.

Source of support: Nil

Conflict of interest: None

Keywords: Hypoxemia, Oxygenation, Ratio of partial pressure of oxygen in arterial blood (PaO₂) and fraction of inspired oxygen (FiO₂).

Dear Editor,

We thank Dr Bhattacharya et al. for their enlightening remarks and interest in our research.¹

In our study, the choice of oxygen delivery vehicle (ODV) was random using the sealed envelope method. The low mean partial pressure of oxygen (PaO₂) in the noninvasive ventilation (NIV) group is purely incidental. The difference between the mean values of the groups was analyzed using the analysis of variance (ANOVA) test, which showed a p-value of 0.994 (after ODV), which was statistically nonsignificant.²

We agree that the risk of postoperative hypoxemia is higher with surgeries involving incision closure to the diaphragm. Considering that concern, we excluded patients with post-thoracotomy and lung surgeries from our study. Although in this open-labeled randomized trial, the distribution of aged patients was incidentally higher in the NIV group than the venturi mask group, the overall age distribution was comparable among the three groups (p = 0.214).

Instead of assessing pain through the visual analogue scale (VAS) score, we analyzed the patient’s compliance with the ODV and ease of communication by COMFORT score.¹ Lower scores indicated more comfort and better communication. Hence, the sedative effect of narcotic analgesics, leading to reduced ventilatory effort, can be overruled. We have also mentioned in the limitations that the evaluation of the patient’s discomfort was based on subjective measures.

We excluded patients with associated comorbidities like chronic obstructive pulmonary disease (COPD) or any other restrictive lung diseases that increase the chances of postoperative pulmonary complications. Such patients were not included in our trial to avoid any adverse outcomes.

As the study was an open-labeled and unmasked trial, selection bias and performance bias were mitigated by using a sealed envelope method of randomization with minimal predictability.^3,4

ORCID

Susri Mishra https://orcid.org/0009-0002-4550-5849

Nikhil Kothari https://orcid.org/0000-0002-9829-905X

Ankur Sharma https://orcid.org/0000-0001-9339-6988

Shilpa Goyal https://orcid.org/0000-0002-8983-0953

REFERENCES

1. Mishra S, Kothari N, Sharma A, Goyal S, Rathod D, Meshram T, et al. Comparison of oxygen delivery devices in postoperative patients with hypoxemia: An open-labeled randomized controlled study. Indian J Crit Care Med 2024;28(3):294–298. DOI: 10.5005/jp-journals-10071-24659.

2. Mishra P, Singh U, Pandey CM, Mishra P, Pandey G. Application of student’s t-test, analysis of variance, and covariance. Ann Card Anaesth 2019;22(4):407–411. DOI: 10.4103/aca.ACA_94_19.

3. Higgins KM, Levin G, Busch R. Considerations for open-label randomized clinical trials: Design, conduct, and analysis. Clin Trials 2024;17407745241244788. DOI: 10.1177/17407745241244788.

4. Mishra S, Kothari N, Sharma A, Goyal S, Rathod DK, Meshram T, et al. Author response: Beyond the nasal prongs: A Joust of oxygen delivery methods in post-op hypoxemia. Indian J Crit Care Med 2024;28(6):626–627. DOI: 10.5005/jp-journals-10071-24740.

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