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CPAP use in carbon monoxide poisoning: Response to concerns

      We are very pleased with the interest shown in our article, entitled “Comparison of non-invasive CPAP with mask use in carbon monoxide poisoning” [
      • Turgut K.
      • Yavuz E.
      Comparison of non-invasive CPAP with mask useincarbonmonoxide poisoning.
      ]. First, I should clarify that this study did not include examining the amount of continuous positive airway pressure (CPAP) to be applied according to the initial carboxyhemoglobin (COHb) level. Our aim was to compare the efficacy of CPAP and a non-rebreather mask in reducing blood COHb levels in carbon monoxide (CO) poisoning and determine which method decreased these levels faster. Therefore, we applied an equal amount of non-invasive mechanical ventilation (NIMV) for 90 min to all patients in the CPAP group. We used the CPAP mode of NIMV and set FiO2 as 100%, PEEP as 5 cm H2O, and pressure support + PEEP as 10 cm H2O (by LTV 1200 portable ventilator) for treatment. If we had applied different FIO2, PEEP or pressure support + PEEP or NIMV for a different period to the patients in the CPAP group, then we may not have achieved objective results. Furthermore, in our study, we determined the 90-min duration based on the case report of Roth et al. [
      • Roth D.
      • Mayer J.
      • Schreiber W.
      • Herkner H.
      • Laggner A.N.
      Acute carbon monoxide poisoning treatment by non-invasive CPAP-ventilation, and by reservoir face mask: two simultaneous cases.
      ]. The different levels of CPAP application according to the COHb level can be a subject to be investigated in a further study.

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