Abstract
We appreciate Dr. Karim, Esquinas and Kumar comments [ [1] Karim H.M.R. Esquinas A. S.K. S. Morphine therapy in acute heart failure is associated with increased mechanical ventilation and mortality: Adverse dose-dependent effect or inevitable consequence?. Int. J. Cardiol. 2019; Abstract Full Text Full Text PDF Scopus (2) Google Scholar ] and thank them for emphasizing several limitations of our study [ [2] Caspi O. Naami R. Halfin E. Aronson D. Adverse dose-dependent effects of morphine therapy in acute heart failure. Int. J. Cardiol. 2019; 293: 131-136 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar ]. At baseline, the oxygen saturation in our study was comparable in patients treated with morphine compared with patients who were not treated with morphine (92 ± 8% vs. 93 ± 7% respectively, P = .051). Baseline lactate levels (prior to morphine administration in the treated group, available in 535 pairs) were also similar between the groups (2.4 ± 1.6 mmol/L vs. 2.5 ± 1.7 mmol/L, P = .37), suggesting that systemic oxygen delivery and tissue hypoxia were not different among the groups. Changes in the level of hypoxemia occurring subsequently may be related, at least in part, to morphine therapy [ [3] Pattinson K.T. Opioids and the control of respiration. Br. J. Anaesth. 2008; 100: 747-758 Abstract Full Text Full Text PDF PubMed Scopus (445) Google Scholar ]. Notwithstanding, because our analysis was retrospective, the clinical decision to initiate ventilation is likely highly variable and can be related to how compelling individual clinicians find particular information.
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