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        "titulo" => "&#205;ndice de agua pulmonar extravascular y fracaso de la ventilaci&#243;n no invasiva&#46; &#191;Es la &#250;ltima frontera para una correcta decisi&#243;n&#63;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The use of non-invasive mechanical ventilation is recommended for treating acute respiratory failure in patients in the post-operative period and for avoiding reintubation&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> However&#44; very few studies are available on objective methods for the early detection of post-operative respiratory failure&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In their article entitled &#8220;Elevated extravascular lung water index &#40;ELWI&#41; as a predictor of failure of continuous positive airway pressure via Helmet &#40;Helmet-CPAP&#41; in patients with acute respiratory failure after major surgery&#8221;&#44; the authors performed a subanalysis to evaluate the correlation between the PICCO monitoring parameters and reintubation&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> They analyzed patients undergoing abdominal surgery&#44; and concluded that respiratory rate&#44; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> index&#44; extravascular lung water index &#40;EVLWI&#41;&#44; pulmonary vascular permeability index &#40;PVPI&#41; are all sensitive and specific indicators of the need for reintubation in patients initially treated with NIV&#46; Moreover&#44; EVLWI and PVIP would be earlier prognostic factors&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We believe that this study is a very interesting discussion of models for predicting post-operative respiratory failure&#46; Moreover&#44; these diagnostic factors would be of great value if incorporated into post-operative intubation protocols&#46; However&#44; in our opinion&#44; 3 aspects must be taken into consideration in order to correctly interpret pulmonary water levels measured by EVLWI and PVPI and to decide on the use of NIV&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Firstly&#44; it is surprising that a significant difference in respiratory rates and the PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> index between intubated patients and non-intubated patients is observed only after 1<span class="elsevierStyleHsp" style=""></span>h of NIV&#44; but not at the beginning of treatment&#44; since these values are equally altered in respiratory failure&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Secondly&#44; it would be interesting to specify why the intubated group received a significantly higher level of CPAP and FiO<span class="elsevierStyleInf">2</span>&#44; considering that the severity criteria before starting NIV were similar&#46; Moreover&#44; it would be very useful to know the cause&#40;s&#41; of NIV failure&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Taking into account that EVLWI and PVPI values would be primarily altered by a parenchymal lesion&#44; rather than fluid overload&#44; other factors and mechanisms might have to be taken into account in NIV failure&#44; such as concomitant lung disease&#44; intraoperative complication&#44; fluid overload&#44; or persistence of the residual effect of sedation and analgesia&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Lastly&#44; in their final conclusions&#44; the authors recommend &#8220;immediate early intubation&#8221; without previous application of NIV if EVLWI and PVPI rise to values associated with an increase in lung water&#46; We are of the opinion that this approach may be contemplated in real-life practice in extreme cases&#44; but in mild-moderate forms of inflammatory lung lesions &#40;acute lung injury-acute respiratory distress syndrome&#41;&#44; NIV could be administered by trained staff to highly selected patients&#44; with an acceptable chance of success&#44; thus avoiding the mortality associated with reintubation or prolonged mechanical ventilation&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a> Further studies are needed to establish whether EVLWI and PVPI values can be used as early prognostic factors of NIV failure&#46;</p></span>"
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Letter to the Editor
Extravascular Lung Water Index as a Predictive Factor for Non-Invasive Ventilation Failure. The Last Chance to Make the Right Decision?
Índice de agua pulmonar extravascular y fracaso de la ventilación no invasiva. ¿Es la última frontera para una correcta decisión?
Antonio M. Esquinasa,
Corresponding author
antmesquinas@gmail.com

Corresponding author.
, Fernanda Tagliaferrib, Maria Barbagallob
a Unidad de Cuidados Intensivos, Hospital Morales Meseguer, Murcia, Spain
b Department of Anesthesia, Intensive Care and Pain Therapy, University Hospital of Parma, Parma, Italy
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ISSN: 15792129
Original language: English
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