Safety considerations regarding noninvasive positive pressure ventilation following esophagectomy.

I read with great interest the article by Raman et al 1 in a recent issue of CHEST (February 2015) that evaluated the pressure tolerance of esophagectomy anastomosis ex vivo and in vivo in a pig model in comparison with esophageal pressure during noninvasive positivepressure ventilation (NPPV). Th e authors showed that anastomosis can tolerate higher pressures than those transmitted to the esophagus during NPPV, thus demonstrating the safety of NPPV after esophagectomy. 1 Despite these data, however, in the clinical setting caution is necessary for several reasons when using pressures . 20 cm H 2 O during NPPV after esophagectomy.