Non-invasive ventilation for treatment of postoperative respiratory failure after oesophagectomy.
BACKGROUND
The aim of this case-control study was to compare the efficacy of non-invasive positive pressure ventilation (NPPV) with that of conventional treatment in patients who develop postoperative acute respiratory failure (ARF) after oesophagectomy.


METHODS
Thirty-six consecutive patients with ARF treated by NPPV were matched for diagnosis, age within 5 years, sex, preoperative radiochemotherapy and Charlson co-morbidity index with 36 patients who received conventional treatment (control group).


RESULTS
NPPV was associated with a lower reintubation rate (nine versus 23 patients; P = 0.008), lower frequency of acute respiratory distress syndrome (eight versus 19 patients; P = 0.015), and a reduction in intensive care stay (mean(s.d.) 14(13) versus 22(18) days; P = 0.034). Anastomotic leakage was less common in patients receiving NPPV (two versus ten; P = 0.027). These patients also showed a greater improvement in gas exchange in the first 3 days after onset of ARF (P = 0.013).


CONCLUSIONS
The use of NPPV for the treatment of postoperative ARF may decrease the incidence of endotracheal intubation and related complications, without increasing the risk of anastomotic leakage after oesophagectomy.
Michelet
P
P
Service de Réanimation, Pôle Réanimation-Urgence-Service d'Aide Médicale Urgente-Hyperbarie, Marseilles, France. pierre.michelet@ap-hm.fr
D'Journo
X B
XB
Seinaye
F
F
Forel
J M
JM
Papazian
L
L
Thomas
P
P
D000208:Acute Disease; D000704:Analysis of Variance; D016022:Case-Control Studies; D003422:Critical Care; D016629:Esophagectomy; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000209:etiology; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000628:therapy*; D013529:Surgical Wound Dehiscence