Early tracheal extubation after liver transplantation

Neelakanta, Gundappa; Sopher, Michael; Chan, Susan Chi-hum; Pregler, Johnathan; Steadman, Randolph H.; Braunfeld, Michelle; Csete, Marie

doi:10.1016/s1053-0770(97)90207-x

Cited by 56 publications

(51 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is significant in terms of economic resources and may limit early extubation and High Dependency Unit (HDU) care for these patients. 12,13 Many factors are likely to contribute to pulmonary edema after OLT, including the preexisting condition of the patient. Patients with fulminant hepatic failure undergoing transplantation represent a clinically different group in terms of preoperative pulmonary function from those undergoing elective procedures.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Edema in Patients After Liver Transplantation

Snowden

Hughes

Rose

et al. 2000

Liver Transplantation

View full text Add to dashboard Cite

The aim of this study is to determine the incidence of radiological pulmonary edema in elective liver transplant recipients and its relationship to perioperative factors and postoperative course. We reviewed 102 chest radiographs from 34 patients who had undergone orthotopic liver transplantation (OLT). Films were assessed by 2 trained radiologists for evidence of pulmonary edema using a standardized system. Clinical and outcome data from the 34 patients were also recorded. There was a high incidence (47%) of postoperative radiological pulmonary edema that was associated with deterioration in gaseous exchange, elevated pulmonary artery pressure, and increased duration of ventilator dependence and intensive care stay. Eighteen percent of the patients developed edema immediately after surgery, which was associated with greater pulmonary artery pressure and transfusion requirements during surgery. An additional 29% developed edema during the next 16 to 20 hours, but there was no association with fluid replacement. We conclude that pulmonary edema is common after OLT and will influence postoperative recovery in a substantial proportion of transplant recipients. Excess perioperative fluid replacement is unlikely to be the sole mechanism of edema in these patients. A fter elective orthotopic liver transplantation (OLT), pulmonary complications are an important source of morbidity that frequently impede recovery. 1,2 Their prevalence is shown by the fact that pulmonary failure is responsible for 25% of readmissions to the intensive therapy unit (ITU). 3 There is no single process accounting for the pulmonary complications, but they can be classified into infective and noninfective causes. Infective pulmonary complications become an important cause of morbidity during the first few months after transplantation but are uncommon in the early transplantation period (Ͻ2 days). Noninfectious complications, including atelectasis, pleural effusion, pulmonary edema, pulmonary embolism, and diaphragmatic dysfunction, make up the majority of early problems. Of all pulmonary complications after elective OLT, 50% to 64% 3,4 are noninfectious. This proportion is greater than that with other organ transplantation procedures. 5 Many episodes of pulmonary edema occur in patients with fulminant hepatic failure, 6 and in such patients these may predict acute lung injury. Some episodes of pulmonary edema that occur after elective OLT may represent less severe acute lung injury. These complications should perhaps be treated differently. The aim of the present study is to determine the incidence of radiological pulmonary edema after elective OLT. The relationship of edema to relevant clinical cardiorespiratory indices, transfusion requirements, and early postoperative ITU recovery was also investigated. MethodsData from 34 patients with chronic liver disease undergoing consecutive OLTs during a 1-year period were included on the study. Patients with fulminant hepatic failure were specifically excluded from the study.Patients were anesthetiz...

show abstract

Section: Discussionmentioning

confidence: 99%

Pulmonary Edema in Patients After Liver Transplantation

Snowden

Hughes

Rose

et al. 2000

Liver Transplantation

View full text Add to dashboard Cite

show abstract

“…Moreover, anesthetic management to immediate extubation seems appropriate and the derived guidelines appear acceptable. However, Neelakanta et al 6 described that while tracheal extubation of selected patients at the end of liver transplantation was safe, it did not result in a decreased length of ICU or hospital stay when compared with a similar group of patients who were not extubated early. Other investigators could not prove that the length of ICU stay would be reduced in a liver transplant group receiving remifentanil versus a technique using inhalational drugs.…”

Section: Discussionmentioning

confidence: 99%

“…Neelakanta et al 6 concluded that tracheal extubation of selected patients at the end of liver transplant surgery in the operating room (OR) was safe but did not result in decreased ICU or hospital stay. Age and severity of liver disease may not preclude the immediate extubation of a liver transplant patient, but acute liver failure, encephalopathy, and poor graft function are widely accepted contraindications to early extubation.…”

Section: Introductionmentioning

confidence: 99%

Criteria for immediate postoperative extubation in adult recipients following living-related liver transplantation with total intravenous anesthesia

Cammu

Decruyenaere

Troisi

et al. 2003

Journal of Clinical Anesthesia

View full text Add to dashboard Cite

“…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.…”

Section: Anesthetic Management Of Abdominal Organ Transplantationmentioning

confidence: 99%

Anesthetic Management of Abdominal Surgery

Alagöl¹

2012

Abdominal Surgery

View full text Add to dashboard Cite

Early tracheal extubation after liver transplantation

Cited by 56 publications

References 1 publication

Pulmonary Edema in Patients After Liver Transplantation

Pulmonary Edema in Patients After Liver Transplantation

Criteria for immediate postoperative extubation in adult recipients following living-related liver transplantation with total intravenous anesthesia

Anesthetic Management of Abdominal Surgery

Contact Info

Product

Resources

About