TIMING OF EXTUBATION AFTER ESOPHAGECTOMY

Ventilatory support for 24 h after surgery is standard practice in man y units after oesophagectomy, especially for patients in whom respirat ory problems are anticipated. Weaning difficulties may occur, however, and there is increasing evidence that mechanical ventilation is assoc iated with alveolar trauma. A deliberate change in policy was institut ed in the authors' unit in January 1990 to make early extubation manda tory in all patients undergoing elective oesophagectomy, apart from th ose in whom serious perioperative problems were encountered. The prese nt study compared two sets of patients: group I (n=36) underwent oesop hagectomy in the year before the policy change and group 2 (n=45) oeso phagectomy in the year after. The two groups were similar in age, sex and respiratory risk factors. Early extubation was carried out in 38 p atients in group 2 compared with eight in group 1 (P<0.001). Only two patients in group 2 required prolonged ventilation compared with ten i n group I (P<0.005). No patient in group 2 required reventilation comp ared with seven in group I (P<0.005), and no patient in group 2 who ha d undergone early extubation required delayed ventilation. The mean ve ntilation time and length of stay in the intensive care unit were sign ificantly reduced following the policy change. Early extubation after elective oesophagectomy is an attainable goal and results in a signifi cant reduction in both the morbidity rate and cost of surgery.