Infusion rate was 6.7 ml/kg/h and 11.5 ml/kg/h in the main and control groups, respectively. Morbidity rate was 28.6% (n=4) and 62.5% (n=10) in the main and control groups respectively. Clavien-Dindo IV complications were lung atelectasis (n=2, 14%), pneumonia (n=1, 7%). Hydrothorax required puncture was noted in 1 (7%) case. Acute respiratory failure as complication IVa was in 1 (9%) patient. In the control group complications were registered in 10 (62.5%) patients. Complications I-II degree included lung atelectasis (n=4, 25%), cervical anastomosis failure (n=1, 6%); complications IVa were observed in 8 cases (50%). It was significant respiratory failure with reduced PO2/FiO2<300. Patients of the main group required less time for postoperative mechanical ventilation (120 [90-300] vs. 315 [215-810] min (p=0.02) and ICU-stay (0.83 [0.7-0.8] vs. 1.75 [1.25-2.75] (p=0.0022).
Introduction. Despite increasing trends toward the early initiation of oral feeding after gastrointestinal surgeries, current evidence about feeding patients after esophagectomy (EE) with gastric tube reconstruction has not been convincing. The further research is needed. The present clinical trial aimed to compare the clinical outcomes of early oral feeding (EOF) with late oral feeding following EE with gastric conduit reconstruction. Objectives. To improve the results of treatment of patients after EE with gastric tube reconstruction by choosing the method of nutritional support in the postoperative period. Materials and methods. Forty patients undergoing esophagectomy with gastric conduit reconstruction enrolled in this prospective randomized controlled trial, and were randomly assigned to a group starting EOF on the first postoperative day (POD) and another group that remained nil by mouth and got parenteral feeding until the 5 POD. The clinical and surgical outcomes were compared between the two groups. Results. Comparing the treatment results of both groups, we did not find a statistically significant difference in the number of patients with postoperative complications in the main and control groups. The patients of EOF group had statistically significant earlier gas discharge-2 vs 4 (3-5.5) POD (p = 0.001) and the appearance of stool - 3 (2-3) vs 4 (2-4.5) POD (p = 0.0002). Early activisation and nutrition support, the absence of intestinal paresis allowed us to note a tendency to reduction of the total time of postoperative hospital stay - 7 (6.5-8.5) vs 8 (7-9) POD (p = 0.1). Conclusions. Early oral nutrition in patients who have undergone EE with gastric conduit reconstruction is safe and effective. However, its use in routine practice is possible only if surgical safety is observed and within the framework of a perioperative support program that includes all the components of ERAS protocol.
BACKGROUND: Pulmonary complications in patients who underwent esophagectomy with one-stage esophagoplasty are a frequent cause of death in the intensive care unit (ICU). However, the use of noninvasive ventilation (NIV) in these patients is not indicated because of the failure of esophagogastric anastomosis. Compared with NIV and standard oxygen therapy, high-flow oxygen therapy (HFOT) reduces the rate of transfer to mechanical ventilation (MV) in the case of acute respiratory failure.
AIM: This study aimed to assess the clinical advantages and disadvantages of HFOT in patients with respiratory failure after esophagectomy.
MATERIALS AND METHODS: Ninety patients with esophagectomy were examined. Two groups were formed by randomization: group 1 (n=45) with standard respiratory therapy, incentive spirometry, and nasal oxygen therapy with NIV sessions and low end-expiratory pressure (up to 6 mmHg) and group 2 (n=45) with HFOT. Therapy parameters were selected according to oxygenation (PaO2/FiО2) and saturation (SaО2) index values. Parameter changes, session duration, patients tolerance to respiratory therapy methods (from 1 to 10 points), dynamics of chest X-ray pattern, and duration of treatment in ICU were analyzed.
RESULTS: The advantages of HFOT were the absence of discomfort during the session, possibility to decrease O2 flow required for an adequate level of oxygenation, high flow with controlled O2 fraction allowed to reach target values of oxygenation index, decreased frequency of patients transfer to MV, and time spent in ICU.
CONCLUSIONS: The use of HFOT is justified as part of the complex respiratory therapy in patients with moderate respiratory failure. In patients with severe respiratory failure, HFOT is an alternative to other high-flow techniques and NIV. The choice between these methods should be individualized and depend on the patients condition and ventilation requirement.
Background: The efficiency of early oral feeding (EOF) in the postoperative period is well known. Though in the esophagus surgery doctors still prefer another types of nutritional support after esophagectomy (EE) with immediate gastric tube reconstruction.
Aims: to improve the results of patients treatment after EE with gastric tube reconstruction by choosing the method of nutritional support and to evaluate nutritional status of the patients with EOF.
Materials and methods: weve conducted prospective single-center randomized study. Subtotal esophagectomy with immediate gastric tube reconstruction was performed to 60 patients. In the postoperative period we evaluated the results of treatment, the frequency and severity of complications, as well as anthropometric and laboratory indicators of the nutritional status before the operation, on 1, 3 and 6 postoperative day (POD).
Results: Patients without high risk of malnutrition were randomly divided in 2 groups: main group (n=30) starting EOF on the 1 POD and control group (n=30) that remained nil by mouth and got parenteral feeding within 4 POD. The patients of EOF group had statistically significant earlier gas discharge (2[2;3] POD vs 4[3;6] POD, р = 0,000042) and stool appearance (3[2;4] POD vs 5[4;7] POD, р = 0,000004). There is a tendency of reduction of the duration of postoperative hospitalization in EOF group (8[7;9] POD vs 9[8;9] POD, р=0,13). EOF does not affect on frequency (46,6% vs 53,3%, р=0,66) and character of postoperative complications. After evaluation of the parameters of nutritional status we found statistically significant decrease of prealbumin level on 3 POD in EOF group (0,17 [0,13;0,21] vs 0,2 [0,16;0,34], р=0,03) of due to inability to compensate daily calorie needs in the first days after the operation. At 6 POD prealbumin became the same in both groups. There were no other significant differences between the groups.
Conclusions: EOF after EE with immediate gastric tube reconstruction is safe and effective. EOF doesnt increase the frequency of anastomotic insufficiency and other complications.
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