Postoperative Ventilation in the Recovery Area

We note with concern that Robertson and colleagues advocate against postoperative ventilation following oesophageal resection, yet their study was associated with an overall in-hospital mortality rate of 8.2% which is higher than published results from other centralised UK centres.^1,2

In our unit, we have utilised a similar care pathway, the only difference being that patients are routinely kept intubated and ventilated in the recovery area until the following morning (about 18 h). Between 2000 and 2003, we performed 168 oesophageal resections (57% transhiatal, 43% transthoracic) with a similar ASA categorisation and unplanned ICU admission rate (15.5%) to Robertson et al. but with an in-hospital mortality of 1.3%.²

Postoperative ventilation has a number of benefits. It allows time for the vital functions and oxygenation to be optimised and efficient endobronchial suction and chest physiotherapy to be performed without distress. Recent evidence that early postoperative elevated cytokine levels may predict the occurrence of subsequent septic complications suggests that aggressive treatments such as continued ventilation may be beneficial in a subset of patients.³ It has also been our experience that delays often occur in the intubation of postoperative deteriorating patients. Arguments such as muscle wasting and weaning problems do not apply when the duration of ventilation is kept short. We would argue that Robertson et al. have not made a clear case for abandoning routine postoperative ventilation.