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Table 3 Daily guideline of postoperative care of patients with FTS pathway vs conventional pathway

From: Fast-track surgery improves postoperative clinical recovery and cellular and humoral immunity after esophagectomy for esophageal cancer

Day FTS pathway Conventional pathway
POD1 Jejunostomy tube feeding 500 mL (starting at 20 mL/h) Early postoperative mobilization program (>2 h out of bed) Physical therapy and nebulizers Remove urine catheter Head of bed put at 30° Supply albumin Chest tube to suction Promoted to lung recruitment Total parenteral nutrition Bed rest Gastrointestinal decompression Closed thoracic drainage
POD2 Jejunostomy tube feeding 1000 mL (40 mL/h) Chest tube to suction Expand mobilization (>4 h out of bed) Continue physical therapy and nebulizers Continue supply albumin Nasojejunal tube feeding 500 mL (starting at 20 mL/h) Remove urine catheter With help, sit in the chair 2 times during the day for at least 30 min each time Gastrointestinal decompression Closed thoracic drainage
POD3 Jejunostomy tube feeding 1500 mL (60–80 mL/h) Remove chest tube Remove epidural catheter Expand mobilization (>6 h out of bed) Continue physical therapy and nebulizers Continue supply albumin Nasojejunal tube feeding 1000 mL (40 mL/h) Sit in the chair 3 times for at least 30–60 min each time. With help, walk twice in the hallway. Do deep breathing exercise Remove nasogastric tube Closed thoracic drainage
POD4 Gastrograffin opacification of upper gastrointestine If swallow shows no leak, advance patient to oral drink Jejunostomy tube feeding 1500 mL (60–80 mL/h) Continue physical therapy and nebulizers Education on aspiration precaution Education on chewing and swallowing Nasojejunal tube feeding 1000 mL (40 mL/h) Sit in the chair 3 times today for at least 30–60 min each time. Walk the length of the hallway 3 times Continue to do breathing exercises Closed thoracic drainage
POD5 Jejunostomy tube feeding 1500 mL (60–80 mL/h) Advance patient to a full liquid diet Continue aspiration precautions Continue physical therapy and nebulizers Nasojejunal tube feeding 1500 mL (60–80 mL/h) Walk the length of the hallway 4–5 times. Sit in the chair 3 times today for at least 30–60 min Continue to do breathing exercises
POD6 Increase liquid diet Decrease jejunostomy tube feeding (500 ml or 1000 ml) Continue aspiration precautions Continue physical therapy and nebulizers Nasojejunal tube feeding 1500 mL (60–80 mL/h) Remove chest tube Walk the length of the hallway 4–5 times. Sit in the chair 3 times today for at least 30–60 min Continue to do breathing exercises
POD7 Remove jejunostomy tube Full liquid diet Discharge home on soft diet and liquid diet Continue aspiration precautions Gastrograffin opacification of upper gastrointestine If swallow shows no leak, advance patient to oral drink Nasojejunal tube feeding 1500 mL (60–80 mL/h) Expand mobilization (>4 h out of bed) Continue to do breathing exercises
POD8   Increase liquid diet Decrease jejunostomy tube feeding (500 ml or 1000 ml) Expand mobilization (>6 h out of bed) Continue to do breathing exercises
POD9   Remove nasojejunal tube Full liquid diet Expand mobilization (>6 h out of bed) Continue to do breathing exercises
POD10-11   Soft diet and liquid diet Nearly out of bed Observe whether there is delayed anastomotic leakage
POD12   Discharge home on soft diet and liquid diet