ARTICOLI ORIGINALI   

Minerva Medica 2015 April;106(2):79-86

Copyright © 2015 EDIZIONI MINERVA MEDICA

lingua: Inglese

Efficacy of early bundle therapy on moderate to severe aspiration pneumonia after cervical esophagogastrostomy for esophageal cancer

Liu D. ¹, Lian H. ², Wang J. ³, Li X. ³, Zhao Q. ³, You Q. ³ ✉

¹ Department of Gastroenterology, Affiliated Hospital of Jiangnan University, the Fourth People’s Hospital of Wuxi City, Wuxi, People’s Republic of China; ² Department of Respiratory Medicine, Affiliated Hospital of Jiangnan University, the Fourth People’s Hospital of Wuxi City, Wuxi, People’s Republic of China; ³ Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Jiangnan University, the Fourth People’s Hospital of Wuxi City, Wuxi, C People’s Republic of China

AIM: 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).
CONCLUSION: Early bundle therapy can effectively improve the treatment efficacy for moderate to severe aspiration pneumonia after cervical esophagogastrostomy for esophageal cancer.