Respiratory Management after Radical Operation for Thoracic Esophageal Cancer
Journal of the Japanese Society of Intensive Care Medicine
Respiratory complications are often experienced in the postoperative course of radical operation for thoracic esophageal cancer. Eighty-one patients who underwent radical operations for thoracic esophageal cancer between 1988 and 1993 were divided into two groups. One group of patients (51 cases) were intubated until complete restoration of the cough reflex was confirmed (about one week) . Another group (30 cases) were extubated on the second or third postoperative day with or without cough
... r without cough reflex. The incidence of respiratory complications was investigated in the two groups. The incidence of pneumonia was 43% in the former and 17% in the latter group. The incidence of upper airway troubles (e. g. vocal cord dysfunction and laryngeal edema) was 76% in the former group and 50% in the latter group. The differences between the two groups were significant. Long-term intubation was thought to cause upper airway dysfunction and misswallowing, which might lead to postoperative pneumonia. These results suggest that extubation of the tracheal tube should occur during the early postoperative period to preserve upper airway and laryngopharyngeal function. Insertion of a minitracheotomy tube enabled effective pulmonary physical therapy to proceed in spite of an impaired cough reflex.