Impairment of chest wall mechanics and increased chest wall work of breathing cause postoperative respiratory failure in patients who have undergone radical esophagectomy.

PURPOSE: We verified the hypothesis that impairment of chest wall mechanics would be related to the cause of postoperative respiratory failure in patients undergoing radical esophagectomy.
METHODS: A total of 21 patients were studied. After management with mechanical ventilation to prevent respiratory failure for several days, trial weaning from the ventilator was performed. The patients were divided into a successful weaning group (S group) and an unsuccessful weaning group (US group), depending on the results of the weaning trial. We compared respiratory mechanics and the respiratory work of breathing during weaning from the ventilator between the two groups.
RESULTS: In the US group, lung and chest wall compliance was significantly lower and the development of intrinsic positive end-expiratory pressure (PEEPi) was observed. The work of breathing and the oxygen cost of breathing were significantly higher in the US group. The increased respiratory energy work was due to a moderate increase in lung work and a significant increase in chest wall work.
CONCLUSION: Our results suggested that postoperative respiratory failure was related to increased respiratory energy expenditure, significantly deteriorated chest wall mechanics, and increased chest wall work, all of which are involved in the development of postoperative respiratory failure after radical esophagectomy.