Article

Flow-safe disposable CPAP efficiency in cardiogenic pulmonary oedema

1684 Correspondence / American Journal of Emergency Medicine 38 (2020) 1679-1694

  1. Obesity prevalence: there is no reference to body mass index, which would be very important, since obese patients may present a signif- icant restrictive respiratory mechanical pattern, requiring higher in- sufflation pressures.
  2. Dyspnea/comfort evaluation/measurement. The authors do not use a dyspnea or comfort control scale to objectively compare symp- tom control between the two groups.

Source of support

None.

Declaration of competing interest

None.

Miguel Guia

Pulmonology Department, Hospital Professor Doutor Fernando Fonseca,

IC19, Amadora, 2720-276 Lisbon, Portugal

*Corresponding author at: Rua Tenente General Zeferino Sequeira, n?20,

13?A, Carnaxide, 2790-156 Lisbon, Portugal.

E-mail address: [email protected].

Hilmi Demirkiran Anesthesiology and Reanimation Department, Medical Faculty, Van Yuzuncu Yil University, Tusba, 65080 Van, Turkey

Antonio Esquinas

Intensive Care Unit, Hospital Morales Meseguer, Avenida Marques de Los

Velez s/n, 30500 Murcia, Spain

7 April 2020

https://doi.org/10.1016/j.ajem.2020.04.081

Reference

[1] Ilhan UZ, Kiyan GS, ?zcete E, Yalcinli S, Korgan MB, Altunci YA, et al. Is the flow-safe disposable continuous positive airway pressure (CPAP) system as effective as non- invasive mechanical ventilation (NIMV) in the treatment of acute cardiogenic pulmo- nary oedema? YAJEM-158720. doi:https://doi.org/10.1016/j.ajem.2020.01.034.

Flow-safe disposable CPAP efficiency in cardiogenic pulmonary oedema

Dear Editor,

We are very pleased that our article has been read and evaluated by readers [1]. We would like to answer the questions as follows:

  1. Flow-safe II Disposable CPAP is connected to the gas source by oxy- gen tubing nipple. The pressure setting is done with the connection valve and its change can be monitored with a manometer. It can be adjusted until the desirED flowmeter pressure is obtained. If neces- sary, the flowmeter can be readjusted to obtain desired CPAP pressure.
  2. non-invasive positive pressure ventilation (NPPV) rapidly improves respiratory distress and reduces the need for intubation and even mor- tality in patients with acute cardiogenic pulmonary edema . Therefore, non-invasive mechanical ventilation (NIMV) is indicated as first-line therapy in ACPO. We have written in our article as follows; ‘While NIMV is one of the most preferred modalities in the initial treat- ment of ACPO, the number of devices that can administer NIMV in the

emergency services is limited. For this reason, there may be a need for Alternative devices that can be as effective as NIMV in units with large numbers of patients and with a limited number of devices that can ad- minister NIMV, especially during the pre-hospital period.’

The most important time for the treatment of ACPO is in the emer- gency department time, patients respond dramatically to the NPPV treatment they receive in the first hour. In our study, we consider that we evaluated the response to treatment in the first hour very well.

  1. Chronic obstructive pulmonary disease (COPD) prevalence was higher on NIMV group, we have mentioned it in the limitation section. Nonin- vasive bilevel positive airway pressure support ventilation may be preferable in patients with significant chronic or acute hypercapnia, in- cluding associated COPD. However, we do not think that it is a major concern for mild to moderate hypercapnic patients with pulmonary edema in the use of flow safe CPAP similarly in our study.
  2. Obesity prevalence and body mass index were not recorded in the

study patients since we have a few numbers of morbidly obese pa- tients and usually they applied with other respiratory problems rather than ACPO.

  1. We used a dyspnea scale such as the modified Borg classification to objectively compare symptom control between the two groups.

Ilhan Uz, MD, PhD? Guclu Selahattin Kiyan MD, PhD Enver Ozcete MD, PhD

Sercan Yalcinli MD, PhD Mehmet Birkan Korgan MD, PhD Yusuf Ali Altunci MD, PhD Murat Ersel MD, PhD

Funda Karbek Akarca MD, PhD

Department of Emergency Medicine, Ege University Faculty of Medicine,

Izmir, Turkey

?Corresponding author.

E-mail address: [email protected].

Oguz Yavuzgil MD, PhD

Department of Cardiology, Ege University Faculty of Medicine, Izmir, Turkey

25 April 2020

https://doi.org/10.1016/j.ajem.2020.04.073

References

[1] Uz Ilhan, Kiyan GS, Ozcete E, Yalcinli S, Korgan MB, Altunci YA, et al. 2020. Is the flow-safe disposable Continuous positive airway pressure system as ef- fective as non-invasive mechanical ventilation (NIMV) in the treatment of acute cardiogenic pulmonary oedema? YAJEM-158720https://doi.org/10. 1016/j.ajem.2020.01.034.

Delirium-informed care in emergency departments: Diagnosis and beyond

Delirium, an acute global brain dysfunction, has been reported to af- fect more than 10% of the patients in emergency departments (EDs) [1]. Although patients with delirium are more susceptible to adverse out- comes including mortality and cognitive decline, they are often mis- or under-diagnosed in wards and EDs [2-4]. Additionally, only a limited number of researches have focused on delirium in EDs.

To reduce the burden of delirium among patients in EDs, effective methods for the early detection of delirium and appropriate interven- tion strategies are required [5]. A single validated assessment tool for di- agnosing delirium is desired [5]; however, thus far, not a single stand- alone indicator has fulfilled sufficiently high sensitivity and specificity

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