BAL Fluid Surfactant Protein C Level Is Related to Parenchymal Lung Disease in Children With Sarcoidosis

We appreciate the interest of Dr Barbarito and colleagues in our recent study 1 comparing the total face mask (TFM) with oronasal mask (ONM) for the treatment of acute respiratory failure in patients receiving noninvasive ventilation (NIV). Our primary (mask comfort and time to apply) and secondary (vital signs and gas exchange parameters over time) end points showed no differences. In the interest of conserving space, we did not show the data for the time course of Pa co 2 in the two groups. Figure 1 shows that data after purging of early discontinuers (ie, those who discontinued NIV while still requiring ventilatory assistance) to provide a better idea of evolution over time. Dr Barbarito and colleagues also requested information on the total duration of mechanical ventilation. As they mention, the median duration of NIV use was longer with the ONM than the TFM, excluding the duration of use after switching to the alternative mask. However, when that duration is included, the total duration of NIV was similar. If, as Barbarito and colleagues request, we exclude those who discontinued early, the median duration of NIV tended to be shorter in the ONM group (23 h; interquartile range, 4.6-51.3; n 5 18) than in the TFM group (56.9 h; interquartile range, 15.7-98.4; n 5 12). The reason for these disparities is that more patients discontinued NIV early with a shorter duration of use in the TFM than the ONM group (n 5 16 vs 12, 0.7 vs 3.7 h), and patients using ONM were more apt to switch to the alternative mask (n 5 8 of 16 patients using TFM vs 0 of 12 patients using ONM, P , .05). This disparity in willingness to switch between the two groups is remarkable, and Barbarito and colleagues ask for more detail on the reasons. Of the 12 patients using ONM who discontinued NIV early, fi ve required prompt intubation. Two other patients had do-not-intubate orders and died while using the mask. The other fi ve patients were offered the TFM but declined. One was claustrophobic and refused any other masks; the other four were frightened by the large appearance of the TFM and declined. One of the patients using ONM compared with none of the patients using TNM had previously used NIV at home. As mentioned in the article, 1 respiratory therapists were instructed to apply every effort to encourage patients to use either mask type. However, since blinding was not possible, we cannot exclude the