Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
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.
Frangos SG, Schwartz DR. Continuous Positive Airway Pressure and Postoperative Hypoxemia. JAMA. 2005;293(22):2714-2715. doi:10.1001/jama.293.22.2714-a