[Pneumonia after esophagectomy].
Progress in operation and postoperative management techniques markedly decreased the frequency of severe pulmonary complications after esophagectomy. However, intractable pneumonia, once occurs, is still likely to be fatal. Intensive care should be given to maintenance of the favorable hemodynamic and respiratory status, airway toilet and appropriate use of antibiotics. We routinely put patients on mechanical ventilation during the oliguric period and suction airway secretions with bronchofiberscope twice a day for five days or more. Antibiotics is administrated against highly toxic strains immediately after the operation, and against target strains selected based on cultivative tests thereafter. In 300 patients who underwent esophagectomy with cervicothoracoabdominal dissection from 1985 to 1995, the hospital mortality rate was 4% (12 patients). Pneumonia was a cause of death in 6 of them, who were all operated upon before 1989. In the most recent two years, nine of 75 patients had postoperative pneumonia (two cases of aspiration pneumonia, two of interstitial pneumonia and one of tracheal perforation). Postoperative tracheostomy was done in four patients. From the early stage after operation, bacterial culture tests of the pharyngeal smear and sputum commonly demonstrated agents which generally cause opportunistic infection, such as Candida spp., Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). By site, MRSA was first detected from the pharyngeal smear or sputum in 30 of 38 MRSA-positive patients.
Matsubara
T
T
Cancer Institute Hospital, Tokyo, Japan.
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D006801:Humans; D011014:Pneumonia / Q000209:etiology / Q000628:therapy; D011182:Postoperative Care; D011183:Postoperative Complications
D000900:Anti-Bacterial Agents