In Reply:
We thank Deng et al. for their interest in our recently published article, “Intraoperative Mechanical Power and Postoperative Pulmonary Complications in Noncardiothoracic Elective Surgery Patients: A 10-Year Retrospective Cohort Study.” Indeed, the fraction of inspired oxygen (Fio2) was recorded but not extracted nor analyzed. Our statistical analysis plan did not include the study of Fio2 because we chose to use oxygen saturation measured by pulse oximetry (Spo2) instead. In our center, the systematic intraoperative use of high Fio2 (greater than 0.8) has never been implemented. Fio2 at 0.5 has been the usual practice until recently, when lower values, titrated to maintain Spo2 greater than 95%, have been in use. We therefore believed that Fio2 information constrained in most cases to a very limited range around 0.5 would not be informative. In contrast, several studies have demonstrated the importance of intraoperative Spo2 in the occurrence of postoperative pulmonary complications. In the study by Hino et al., the pulmonary Apgar score (which includes intraoperative Spo2) was able to predict pulmonary complications. More recently, Song et al. showed, in a geriatric patient population, that the occurrence of hypoxemia (indicated by low Spo2) was predictive of postoperative hypoxemia. Therefore, we decided to use episodes of desaturation with Spo2 less than 96% as a more informative variable for assessing intraoperative pulmonary complications and potential confounding factors for postoperative pulmonary complications.
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