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LETTERS TO THE EDITOR

Respiratory Failure After Pneumonectomy in a Patient with Unknown Hyperlipidemia

Department of Anesthesia, National Taiwan University Hospital, Taipei, Taiwan

To the Editor:

We read with interest the article by Bairaktari et al. (1) describing a case about respiratory failure, which may be associated with his hyperlipidemia. This is a new concept about postoperative respiratory failure about which more caution is warranted.

The unit of triglyceride level in blood can be written as mg/dL or mmol/L. The normal range is <160 mg/dL or 1.8 mmol/L (2). We should interpret these laboratory data units with caution because normal values differ widely. Sometimes we use the traditional unit like mg/dL, and sometimes we use the system of international units (SI) like mmol/L. Some mistakes of unit interpretation are present in the article (1).

Aggeliki et al. (1) mentioned the triglyceride level of the patient was 152 mmol/L. That value is beyond the acceptable range because it is above 84 times more than the normal value! The triglyceride level should be 152 mg/dL. The same mistake happened six times. We believe these mistakes may confuse our interpretation about this patient.

Furthermore, we notice the patient’s level of triglyceride was 152 mg/dL during the operative period. The value is within normal limit, and it doesn’t match the definition of hyperlipidemia. After pneumonectomy, the triglyceride level was 81 mg/dL, 79 mg/dL, 80 mg/dL, 60 mg/dL, and 20 mg/dL in sequence. These values are all within normal range. Therefore, we don’t understand why plasma exchange was performed on this patient without any evidence of hyperlipidemia. Perhaps there are other indications for plasmapheresis without mentioning in that article. We would like to receive more information about the patient, especially the decision making about plasma exchange.

References

1. Bairaktari A, Raitsiou B, Kokolaki M, et al. Respiratory failure after pneumonectomy in a patient with unknown hyperlipidemia. Anesth Analg 2001; 93: 292–3.[Abstract/Free Full Text]
2. Fauci AS, Eugene B, Isselbacher KJ, et al. eds. Harrison’s principle of internal medicine. 14th ed. Vol 2, App A-3.

Response

Athens, Greece

In Response:

I read with interest Dr. Guo’s letter and his suggestion that the triglyceride level should be 152 mg/dL. In the entire article, the triglyceride levels are expressed as mmol/L and the values that we found were 152 mmol/L, 81 mmol/L, 79 mmol/L, 80 mmol/L, 60 mmol/L and 20 mmol/L in sequence (normal range, 0.7–1.9 mmol/L).

This was the reason that we performed plasma exchange.

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