Respiratory Care with Fiberoptic Bronchoscopy after Subtotal Esophagectomy

Patients who underwent subtotal esophagectomy were extubated on the first postoperative day in order to avoid postoperative pulmonary complications and discomfort. Extubation was carried out if the patient satisfied the following criteria: no ischemic change in the mucosa, PaO2 greater than 100mmHg, and PaCO2 less than 45mmHg under 2cm H2 O CPAP or a T-piece with an FiO2 of 40%. Fiberoptic bronchoscopy (FBS) was then performed under topical anesthesia to aspirate sputum in the bronchial trees. We retrospectively studied the duration of tracheal intubation and the number of days, on which FBS was required after extubation in 41 patients. They were analyzed with regard to two preoperative measures; one-second forced expiratory volume (FEV 1) greater or less than 2.0L, and smoking history. The duration of tracheal intubation except for two tracheostomy cases was 1.8±1.7 days (mean±SD). Twenty-seven patients (66% of all patients) were extubated on the first postoperative day. The duration of intubation was not affected significantly by the risk factors. However, four patients in whom the duration of intubation was longer than 3 days, and two who required tracheostomy for long-term pulmonary care, were all smokers. FBS was required for 3.7±2.0 days after surgery. The duration of FBS was not affected by the value of FEV 1. However, smokers required FBS for a longer period (4.1±2.2 days) than non-smokers (2.9±1.2 days, p<0.05). Twelve patients who required FBS for more than 5 days were all smokers (p<0.02). We conclude that it is not risky to extubate on the first postoperative day if FBS is performed to clean airway secretions. However patients with a smoking history require prolonged pulmonary care after subtotal esophagectomy.