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June 8, 2005

Continuous Positive Airway Pressure and Postoperative Hypoxemia

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(22):2714-2715. doi:10.1001/jama.293.22.2714-a

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.

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