Managing the patient with perforated intrathoracic esophagus.
The thoracic perioperative specialty team members at Inova Fairfax Hospital, Falls Church, Va, designed guidelines to improve the management of patients with esophageal perforations. They performed a retrospective analysis of 41 patients who were diagnosed with thoracic esophageal perforations from Sept 1, 1979, through Sept 1, 1996. The review affirmed their philosophy of aggressive, surgical intervention for perforations, particularly for patients diagnosed early (i.e., within 24 hours). The process of examining and communicating the results among OR nurses, anesthesia care providers, and surgeons resulted in the increased efficiency and appropriateness with which patients were incorporated into the hospital's surgical and medical treatment groups.