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Michael N. Mavros, MD; George C. Velmahos, MD, PhD; Matthew E. Falagas, MD, DSc
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From the Alfa Institute of Biomedical Sciences (AIBS) (Drs Mavros and Falagas); Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School (Dr Velmahos); Department of Medicine, Henry Dunant Hospital (Dr Falagas); and Department of Medicine, Tufts University School of Medicine (Dr Falagas).

Correspondence to: Matthew E. Falagas, MD, DSc, Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos St, 151 23 Marousi, Athens, Greece; e-mail: m.falagas@aibs.gr


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(1):275. doi:10.1378/chest.11-2206
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To the Editor:

We thank Drs Kane and Backer for their correspondence on our recent article, which contributed to the discussion of the potential association between postoperative fever and atelectasis.1 The authors conducted a retrospective cohort study, examining the potential association between postoperative fever and atelectasis in pediatric patients.2 They concluded that no such association existed, and, thus, postoperative fever should not be attributed to atelectasis.

To our knowledge, a total of three studies, including the one by Drs Kane and Backer,2 have specifically examined this association. In their correspondence, Drs Kane and Backer suggested that no further studies are necessary to confirm the lack of association between atelectasis and postoperative fever and that this old idea should simply be discarded. Unfortunately, it is not so rare in clinical practice for clinicians to choose to follow their own rationale rather than what is suggested by the published evidence; in fact, several such cases have been published so far.3,4

Regarding the potential association of atelectasis and postoperative fever, however, all the published studies have certain limitations, including methodologic concerns and a relatively small sample size. This fact does not allow, at least in our point of view, for firm conclusions to be drawn. Although the rather limited evidence implies no association between atelectasis and postoperative fever, we believe that future well-designed and well-conducted studies will be useful in reaching a safe conclusion, and convincing even the most doubtful minds.

Mavros MN, Velmahos GC, Falagas ME. Atelectasis as a cause of postoperative fever: where is the clinical evidence? Chest. 2011;1402:418-424 [PubMed] [CrossRef]
 
Kane JM, Friedman M, Mitchell JB, Wang D, Huang Z, Backer CL. Association between postoperative fever and atelectasis in pediatric patients. World J Pediatr Congenital Heart Surg. 2011;23:359-363
 
Peppas G, Alexiou VG, Falagas ME. Bowel cleansing before bowel surgery: major discordance between evidence and practice. J Gastrointest Surg. 2008;125:919-920 [PubMed]
 
Pappas G, Siozopoulou V, Akritidis N, Falagas ME. Doxycycline-rifampicin: physicians’ inferior choice in brucellosis or how convenience reigns over science. J Infect. 2007;545:459-462 [PubMed]
 

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Mavros MN, Velmahos GC, Falagas ME. Atelectasis as a cause of postoperative fever: where is the clinical evidence? Chest. 2011;1402:418-424 [PubMed] [CrossRef]
 
Kane JM, Friedman M, Mitchell JB, Wang D, Huang Z, Backer CL. Association between postoperative fever and atelectasis in pediatric patients. World J Pediatr Congenital Heart Surg. 2011;23:359-363
 
Peppas G, Alexiou VG, Falagas ME. Bowel cleansing before bowel surgery: major discordance between evidence and practice. J Gastrointest Surg. 2008;125:919-920 [PubMed]
 
Pappas G, Siozopoulou V, Akritidis N, Falagas ME. Doxycycline-rifampicin: physicians’ inferior choice in brucellosis or how convenience reigns over science. J Infect. 2007;545:459-462 [PubMed]
 
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