Bupivacaine application is effective in decreasing postoperative pain and analgesic requirement during the hospital stay for patients with thyroidectomy.

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In cardiac surgery patients, ARF often occurs on the secondto-third postoperative day, 4 when most patients have been discharged from the ICU. Therefore, the treatment of postoperative hypoxemia is part of the surgical ward handling, and studies demonstrating safety and effectiveness of the use of NIV to treat postoperative ARF outside the ICU are warranted. A few years ago, we performed an observational study on the safety of NIV application in the cardiac surgical ward to treat postoperative ARF, 5 whereas in the present study we have undertaken a randomized study of the efficacy of CPAP to treat postoperative hypoxemia. 1 Our results appear likely to carry external validity because we used pragmatic inclusion criteria and few exclusion criteria. CPAP is an inexpensive technique and is easy to apply. These features make it suitable to the main ward where there are no ventilators and where the staff-patient ratio is low. During our study, no CPAP-related complications were noted. However, we do not encourage a generalization of our protocol for all the cardiac surgery wards because the efficacyand safety of NIV outside of the ICU depend strongly on ward training, experience, monitoring capabilities, and organization. Preliminary and periodic training for all the staff, protocols, monitored beds, the possibility of prompt intubation when indicated, data collection and analysis of outcomes, and continuous quality improvement are all elements that are essential to make a ward fit for NIV.