title: Efficacy of early bundle therapy on moderate to severe aspiration pneumonia after cervical esophagogastrostomy for esophageal cancer.
abstract: OBJECTIVE
  The aim of this paper was to investigate the methodology and clinical efficacy of early bundle therapy for complicated moderate to severe aspiration pneumonia after cervical esophagogastrostomy for esophageal cancer.
  
  
  METHODS
  A prospective study was conducted to analyze the clinical data from 49 patients who developed complicated moderate to severe aspiration pneumonia after cervical esophagogastrostomy for esophageal cancer. Among them, 27 patients underwent a bundle therapy-tracheostomy followed by ventilator-assisted breathing with reverse trendelenburg position, early goal-directed hemodynamic support, enteral nutrition by nasointestinal tube, effective antibiotic usage and large doses of expectorants in addition to the conventional treatments. The remaining 22 patients underwent conventional treatment (controls). The hospital fatality rates, incidence of serious complications, mechanical ventilation time and ICU length of stay of the two groups were compared.
  
  
  RESULTS
  Patients in the bundle therapy group had higher cure rate of pneumonia than the control group (P=0.041), significantly lower fatality rate than the controls (P=0.005), lower incidence of complications than the controls (P<0.05), shorter ICU length of stay than the control group (P=0.017), significantly shorter mechanical ventilation time (P=0.032), lower Acute Physiology and Chronic Health Evaluation II Score (P=0.036) and lower Clinical Pulmonary Infection Score (P=0.047).
  
  
  CONCLUSIONS
  Early bundle therapy can effectively improve the treatment efficacy for moderate to severe aspiration pneumonia after cervical esophagogastrostomy for esophageal cancer.
authors.affiliation: Department of Gastroenterology, Affiliated Hospital of Jiangnan University, the Fourth People's Hospital of Wuxi City, Wuxi, People's Republic of China - wxsytsg@126.com.
authors.forename: D
authors.initials: D
authors.lastname: Liu
authors.forename: H
authors.initials: H
authors.lastname: Lian
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.forename: X
authors.initials: X
authors.lastname: Li
authors.forename: Q
authors.initials: Q
authors.lastname: Zhao
authors.forename: Q
authors.initials: Q
authors.lastname: You
mesh_terms: D000368:Aged; D061345:Early Medical Intervention; D004938:Esophageal Neoplasms / Q000601:surgery*; D004946:Esophagostomy / Q000379:methods; D005260:Female; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009333:Neck; D064872:Patient Care Bundles; D011015:Pneumonia, Aspiration / Q000628:therapy*; D011183:Postoperative Complications / Q000628:therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome