Document Detail


Non-Invasive Positive Pressure Ventilation Following Esophagectomy: Safety Demonstrated in a Pig Model.
MedLine Citation:
PMID:  25317776     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract: Background:Respiratory complications occur in 20-65% of esophagectomy patients. While non-invasive positive pressure ventilation (NPPV) is associated with fewer complications than endotracheal intubation (ET), it is relatively contraindicated after esophagectomy due to potential injury to the anastomosis. We created an ex vivo and in vivo pig model to determine the pressure tolerance of an esophagectomy anastomosis and compare it to esophageal pressure during NPPV. Methods:We created a stapled side-to-side, functional end-to-end esophagogastric anastomosis. With continuous intraluminal pressure monitoring, we progressively insufflated the anastomosis with a syringe until we detected an anastomotic leak, and recorded the maximum pressure before leakage. We performed this experiment in 10 esophageal specimens and 10 live pigs. We then applied a laryngeal mask airway (LMA) to five live pigs and measured the pressure in the proximal esophagus with increasing ventilatory pressures. Results:The perforation was always at the anastomosis. The ex vivo and in vivo anastomoses tolerated a mean of 101±44 cm H2O (95% CI) and 84±38 cm H2O before leak, respectively. There was no significant difference between the pressure thresholds of ex vivo and in vivo anastomoses (p=0.51). When 20, 30, and 40 cm H2O of positive pressure via LMA were delivered, the esophagus sensed 5±4 cm H2O (25%), 11±11 cm H2O (37%), and 15±9 cm H2O (38%), respectively. Conclusions:Our pig model suggests that an esophagectomy anastomosis can tolerate a considerably higher pressure than is transmitted to the esophagus during NPPV. NPPV may be a safe alternative to ET after esophagectomy.
Background: Respiratory complications occur in 20-65% of esophagectomy patients. While non-invasive positive pressure ventilation (NPPV) is associated with fewer complications than endotracheal intubation (ET), it is relatively contraindicated after esophagectomy due to potential injury to the anastomosis. We created an ex vivo and in vivo pig model to determine the pressure tolerance of an esophagectomy anastomosis and compare it to esophageal pressure during NPPV.
Methods: We created a stapled side-to-side, functional end-to-end esophagogastric anastomosis. With continuous intraluminal pressure monitoring, we progressively insufflated the anastomosis with a syringe until we detected an anastomotic leak, and recorded the maximum pressure before leakage. We performed this experiment in 10 esophageal specimens and 10 live pigs. We then applied a laryngeal mask airway (LMA) to five live pigs and measured the pressure in the proximal esophagus with increasing ventilatory pressures.
Results: The perforation was always at the anastomosis. The ex vivo and in vivo anastomoses tolerated a mean of 101±44 cm H2O (95% CI) and 84±38 cm H2O before leak, respectively. There was no significant difference between the pressure thresholds of ex vivo and in vivo anastomoses (p=0.51). When 20, 30, and 40 cm H2O of positive pressure via LMA were delivered, the esophagus sensed 5±4 cm H2O (25%), 11±11 cm H2O (37%), and 15±9 cm H2O (38%), respectively.
Conclusions: Our pig model suggests that an esophagectomy anastomosis can tolerate a considerably higher pressure than is transmitted to the esophagus during NPPV. NPPV may be a safe alternative to ET after esophagectomy.
Authors:
Vignesh Raman; Caitlyn E MacGlaflin; Cherie P Erkmen
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-10-9
Journal Detail:
Title:  Chest     Volume:  -     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2014 Oct 
Date Detail:
Created Date:  2014-10-15     Completed Date:  -     Revised Date:  2014-10-16    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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