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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We share the concerns expressed by Quintero et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> on comfort and air leakage during non-invasive mechanical ventilation &#40;NIMV&#41; with the need of using oral or naso-oral probes&#46; The authors designed their device aiming to decrease air leaks to improve patient comfort&#44; which is related to success of NIMV&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">After reading the article&#44; we found several discussion points&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">First&#46; We think that the selection of patients included as their own controls is a success&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Second&#46; Quintero et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> included 196 patients but there is no flowchart explaining how many patients met the inclusion criteria and how many were excluded and the reasons&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Third&#46; To asses comfort&#44; they used a qualitative ordinal scale with only 5 options to choose from&#46; When using that type of scales&#44; there could be a tendency of regression toward the central value&#44; so that measurement bias could appear&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Fourth&#46; It is not explained if patients begin with NIVM using the adapter or the conventional tube&#46; If a patient first receives the most uncomfortable one&#44; when it is changed to the comfortable one&#44; his perception of comfortability may be higher&#46; We believe that this matter should have been addressed&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Fifth&#46; The authors estimated a sample size of 191 patients and they included 196 patients in the study but comfort was evaluated only in 99 patients with Glasgow Coma Scale of 15&#44; so sample size was not reached for one of the outcome of interest&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Sixth&#46; Respiratory and hemodynamic parameters during NIMV&#44; such as inspiratory and expiratory tidal volumes&#44; oxygen saturation and respiratory rate&#44; were better in the NIMV with tube adaptor group&#44; but it is difficult to know if it was the result of TA-NIMV alone or the sum of both therapies&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Seventh&#46; Therapy was performed according to individual needs&#44; so patients could have received different therapies and that heterogeneity could make patients non-comparable&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Quintero et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> concluded that the use of their tube adaptor to adjust NIMV mask interfaces in patients in whom oro or naso-enteral tubes were in place&#44; significantly reduced air leaks and improved subjective comfort perceived by the patient during NIMV support&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">As there has been no important changes in recommendations published within the past 15 years regarding the use of NIMV for various forms of respiratory failure <a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a>&#44; we believe that proposals like Quintero&#39;s gastric feeding tube adaptor may improve the assistance of patients with respiratory failure during NIMV&#44; even though further studies should be performed to correct biases&#46;</p></span>"
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