A multicenter evaluation of safety of early extubation in liver transplant recipients

Abstract

Small single-institutional studies performed prior to the introduction of organ allocation using the Model for End-Stage Liver Disease (MELD) suggest that early airway extubation of liver transplant recipients is a safe practice. We designed a multicenter study to examine adverse events associated with early extubation in patients selected for liver transplantation using MELD score. A total of 7 institutions extubated all patients meeting study criteria and reported adverse events that occurred within 72 hours following surgery. Adverse events were uncommon: occurring in only 7.7% of 391 patients studied. Most adverse events were pulmonary or surgically related. Pulmonary complications were usually minor, requiring only an increase in ambient oxygen concentration. The majority of surgical adverse events required additional surgery. Analysis of a limited set of perioperative variables suggest that blood transfusions and technical factors were associated with an increased risk of adverse events. In conclusion, while early extubation appears to be safe under specified circumstances, there are performance differences between institutions that remain to be explained. Liver Transpl 13:1557Transpl 13: -1563Transpl 13: , 2007

Perioperative Care of the Liver Transplant Patient

“…23 In a study involving 7 centers (5 in the United States, 2 in Europe), 391 patients were extubated within 1 hour of completion of LT surgery. 26 Adverse events within 72 hours occurred in 7.7% of them. The events were mostly minor and there was considerable intercenter variability.…”

Critical Care Management after Adult Liver Transplantation

“…Birçok merkezde elektif KT uygulandığında hastalar operasyon bitiminde kardiyovasküler, solunumsal ve metabolik olarak stabilse ve ekstübasyon kriterlerini içeriyorsa ameliyathanede ekstübe edilip YBÜ'de izlenirler veya daha nadir olarak bazı merkezlerde olduğu gibi bir süre PABÜ'de izlendikten sonra servise çıkarılırlar (5,85). Uygun hastalarda gerçekleştirilen erken ekstübasyonun greft fonksiyonunu iyileştirdiği, YBÜ'de kalış süresini ve maliyeti azalttığı, nozokomiyal enfeksiyon oranını düşürdüğü gösterilmiştir.…”

Anesthetic Management of Abdominal Surgery

“…After liver transplantation, patients can be extubated in the operating room (11)(12)(13)(14). On the other hand, close monitoring and laboratory tests have to be continued in the ICU.…”