title: Noninvasive positive pressure ventilation for the treatment of acute respiratory distress syndrome following esophagectomy for esophageal cancer: a clinical comparative study.
abstract: OBJECTIVE
  To evaluate the therapeutic efficacy of noninvasive positive pressure ventilation (NPPV) in the treatment of acute respiratory distress syndrome (ARDS) following esophagectomy for esophageal cancer.
  
  
  METHODS
  In this retrospective evaluation, we included 64 patients with ARDS following esophagectomy for esophageal cancer between January 2009 and December 2011. The primary evaluations were 28-day fatality and actual fatality. The secondary evaluations were sex, age, onset time, pH value, PaO2/FiO2, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHE-II) score, and presence or absence after surgery of major surgery-related complications such as cardiac arrest, anastomotic fistula, and acute renal dysfunction.
  
  
  RESULTS
  NPPV applied as the first-line intervention for ARDS following esophagectomy for esophageal cancer avoided intubation in 30 patients (30/64, 48.4%). There were no significant differences in gender, age, PaO2/FiO2, SOFA score, or APACHE-II score between the NPPV group and the patients who required invasive positive pressure ventilation (IPPV group) (P>0.05) at the time of onset, while differences in the PaO2/FiO2 (P<0.05) after 24 h of NPPV and presence of major surgery-related complications were highly significant (P<0.01).
  
  
  CONCLUSIONS
  NPPV may be an effective option for the treatment of ARDS/acute lung injury (ALI) following esophagectomy for esophageal cancer. However, conversion to invasive mechanical ventilation should be considered in patients with severe postoperative complications such as acute renal dysfunction and cardiac arrest and in those with PaO2/FiO2 <180 after 2 h of NPPV.
authors.affiliation: Department of Surgery Intensive Care Unit, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China;
authors.forename: Kai-Yan
authors.initials: KY
authors.lastname: Yu
authors.affiliation: Department of Physiology, School of Basic Science, Guangzhou Medical University, Guangzhou 510282, China;
authors.forename: Lei
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Zi
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Surgery Intensive Care Unit, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China;
authors.forename: Min
authors.initials: M
authors.lastname: Yang
keywords: Noninvasive positive pressure ventilation (NPPV); acute respiratory distress syndrome (ARDS); esophagectomy