Perioperative respiratory care in patients undergoing esophagectomy

Despite recent advances in surgical techniques and perioperative management, the rate of perioperative complications after esophagectomy, one of major surgical interventions, remains high compared to those of other surgical procedures. Respiratory complications are often observed and sometimes serious and life-threatening unless treated appropriately. Thus, certain prevention and adequate treatment of perioperative respiratory complications during perioperative periods are imperative to improve the outcome of patients with esophageal cancer. Prior to surgery, smoking cessation is extremely important to reduce the risk of respiratory complications. Moreover, preoperative oral care has been shown to prevent postoperative pneumonia During surgery, lung protective strategy and goal-directed fluid management have been reported to prevent the development of acute lung injury and to reduce postoperative respiratory complications. Postoperatively, sufficient analgesia and early mobilization therapy could promote recovery of respiratory function after esophagectomy. Compared with conventional oxygen therapy, nasal high-flow therapy might promote better recovery of respiratory functions owing to clearance of tracheal secretions, additional positive end-expiratory pressure, and reduced work of breathing.