Respiratory failure after ivor Lewis esophagogastrectomy

diana818

My father had the surgery done on May 3rd. In the first week my father was doing excellent. He passed the swallow test. However after the first week he was having major breathing problems. On May 15th my father was put on a Ventalitor. They did cultures on everything which includes blood, chest fluid and abdominal (fluid was found in abdominal in ct scan) which have all been negative. For the first 2 weeks my father was on the vent at 60% fio2. Last Wed my fathers CO2 went up to the 80s. On Friday night my fathers blood gas was not good and the vent had to moved up to fio2 100%. For the past 2 days his fio2 setting ranges from 80-100. The doctors can not do anything because he is too ill to be moved around. He has already been on 4 different antibiotics and none of them has shown any results. Anyone with any past experience of input on this is greatly appreciated! Thanks

Donna70

no experience with this
Dear Diana,
I had the Ivor Lewis surgery and did not have post op respiratory difficulties. We did have a member Lori whose husband Jeff had respiratory problems after surgery and was in the ICU for quite awhile. He is now doing fine now but he had had a pretty rough post surgery time. Maybe someone else can answer your questions. I will keep your Dad in my prayers and you too, this sounds like quite a rough course. take care,
Donna70

BMGky

Donna70 said:

no experience with this
Dear Diana,
I had the Ivor Lewis surgery and did not have post op respiratory difficulties. We did have a member Lori whose husband Jeff had respiratory problems after surgery and was in the ICU for quite awhile. He is now doing fine now but he had had a pretty rough post surgery time. Maybe someone else can answer your questions. I will keep your Dad in my prayers and you too, this sounds like quite a rough course. take care,
Donna70

Donna I'm glad you posted
I had read her post and was concerned, but like you, my husband didn't have the respiratory problems either. He was short of breath, but that has improved to the point that it is not noticeable except in the most extreme situation. I do hope they get his breathing under control. I didn't know what to say, but you said it very well. I will pray for him to get better. Mary

diana818

BMGky said:

Donna I'm glad you posted
I had read her post and was concerned, but like you, my husband didn't have the respiratory problems either. He was short of breath, but that has improved to the point that it is not noticeable except in the most extreme situation. I do hope they get his breathing under control. I didn't know what to say, but you said it very well. I will pray for him to get better. Mary

Thank you for the response Donna and Mary
I will be having a meeting with the doctors tomorrow. Will update you soon. Thanks again!

DanaM

Went thru the same thing
Diana,
My husband went into Presby UMPC for the MIE on April 27, of this year. He got thru the surgery just fine and told me when I came to see him in the PACU, that “it looks worse than it is, hon.” The following day, they were preparing to move him into a room on a regular floor for thoracic surgery patients. I was on my way back to the hospital after going home to take a brief shower and my husband called to give me his room number. But he was saying things that were out of character for him and asked me how far away I was. I told him I was on the shuttle and about 10 minutes away,

When I arrived in his room, he was disoriented. The nurse who was assigned to him was inexperienced and blamed his condition on “ICU psychosis.” As he became more and more combative, I actually had to use my own body to keep him in bed. After 8 hours of ranting and raving, I finally convinced a doctor to send him back to the ICU, whereupon they found elevated levels of CO2- which in short means that he was suffering from hypoxia, i.e. a lack of oxygen.

Immediately his oxygen levels fluctuated and was diagnosed with pneumonia. The next few weeks proved to be an emotional roller coaster consisting of the administration of numerous antibiotics and intubation/connection to a ventilator. At one point, he desaturated to the low 80’s, whereupon I was asked to leave the ICU and he almost died. The ICU doctor turned him over on his stomach and his oxygen levels rose. Therefore, they promptly ordered a rotoprone bed, which allows a patient that is on a ventilator to lie suspended, hooked in with seatbelts and such, in a position that allows the patient to be placed supine and every 10 minutes or so, the bed would rotate on a 45 degree angle to the left and right. The advantage of this is that the fluid that has accumulated on the lung is moved by gravity and the injured parts of the lung are given the opportunity to breathe. There were only 3 of these beds in existence in the UMPC system. These beds save lives.

When he improved and was removed from the bed, they still had to place a chest tube in his right lung to drain fluids and they removed an entire litre. Weaning off of a ventilator is a process and they did place a tracheotomy on my husband for his comfort as it is difficult to allow patients who are intubated to become fully conscious. After he spent 6-7 days inside of the bed and subsequent chest tube placed in to drain the remaining fluid, be prepared to see things such as spikes in the heart rate, fluctuations in the blood pressure, either too high or dangerously low, continuous antibiotic changes, as they culture the lung mucus (make sure they are treating him with an antifungal as well) and in general a really crazy ride until you reach some stable ground. A women who came in for the same surgery, endured this same problem and had an identical treatment path and problems-minus the rotoprone bed.

An chest x-ray should be taken every day, CAT scans every few days, and blood cultures and cultures of the fluids in his lungs should be sent to the lab every day to insure that the proper antibiotics are given. The rotoprone, although very frightening, saves lives where this particular problem rears its ugly head. We spent 4 weeks in the ICU before we could go to a regular room again. Take heart, it is a process, but please ask about the rotoprone. Apparently, this issue is far more common than what you are told prior to this procedure. God Bless U, you will be in my prayers. Please email me if you have any other questions that I can answer.

Unknown

DanaM said:

Went thru the same thing
Diana,
My husband went into Presby UMPC for the MIE on April 27, of this year. He got thru the surgery just fine and told me when I came to see him in the PACU, that “it looks worse than it is, hon.” The following day, they were preparing to move him into a room on a regular floor for thoracic surgery patients. I was on my way back to the hospital after going home to take a brief shower and my husband called to give me his room number. But he was saying things that were out of character for him and asked me how far away I was. I told him I was on the shuttle and about 10 minutes away,

When I arrived in his room, he was disoriented. The nurse who was assigned to him was inexperienced and blamed his condition on “ICU psychosis.” As he became more and more combative, I actually had to use my own body to keep him in bed. After 8 hours of ranting and raving, I finally convinced a doctor to send him back to the ICU, whereupon they found elevated levels of CO2- which in short means that he was suffering from hypoxia, i.e. a lack of oxygen.

Immediately his oxygen levels fluctuated and was diagnosed with pneumonia. The next few weeks proved to be an emotional roller coaster consisting of the administration of numerous antibiotics and intubation/connection to a ventilator. At one point, he desaturated to the low 80’s, whereupon I was asked to leave the ICU and he almost died. The ICU doctor turned him over on his stomach and his oxygen levels rose. Therefore, they promptly ordered a rotoprone bed, which allows a patient that is on a ventilator to lie suspended, hooked in with seatbelts and such, in a position that allows the patient to be placed supine and every 10 minutes or so, the bed would rotate on a 45 degree angle to the left and right. The advantage of this is that the fluid that has accumulated on the lung is moved by gravity and the injured parts of the lung are given the opportunity to breathe. There were only 3 of these beds in existence in the UMPC system. These beds save lives.

When he improved and was removed from the bed, they still had to place a chest tube in his right lung to drain fluids and they removed an entire litre. Weaning off of a ventilator is a process and they did place a tracheotomy on my husband for his comfort as it is difficult to allow patients who are intubated to become fully conscious. After he spent 6-7 days inside of the bed and subsequent chest tube placed in to drain the remaining fluid, be prepared to see things such as spikes in the heart rate, fluctuations in the blood pressure, either too high or dangerously low, continuous antibiotic changes, as they culture the lung mucus (make sure they are treating him with an antifungal as well) and in general a really crazy ride until you reach some stable ground. A women who came in for the same surgery, endured this same problem and had an identical treatment path and problems-minus the rotoprone bed.

An chest x-ray should be taken every day, CAT scans every few days, and blood cultures and cultures of the fluids in his lungs should be sent to the lab every day to insure that the proper antibiotics are given. The rotoprone, although very frightening, saves lives where this particular problem rears its ugly head. We spent 4 weeks in the ICU before we could go to a regular room again. Take heart, it is a process, but please ask about the rotoprone. Apparently, this issue is far more common than what you are told prior to this procedure. God Bless U, you will be in my prayers. Please email me if you have any other questions that I can answer.

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