Immediate versus conventional postoperative tracheal extubation for enhanced recovery after liver transplantation

Abstract

Introduction:To systematically compare immediate postoperative tracheal extubation (IPTE) with conventional tracheal extubation (CTE) and to determine whether IPTE can achieve an enhanced recovery for adult patients underwent liver transplantation (LT) without additional risks. We designed a systematic review and meta-analysis.Methods:The RCTs, cohorts, case–controls, or case series that explored outcomes of IPTE after LT for adults were involved in our study. The Newcastle–Ottawa scale was used to assess the risk of bias.Results:A total of 15 studies (n = 4144) were included, consisting of 10 studies (retrospective cohorts; n = 3387) for quantitative synthesis and 5 studies (1 prospective cohort, and 4 case series; n = 757) for qualitative synthesis. The pooled estimates suggested IPTE could reduce time to discharge from ICU stay (TDICU) (mean difference [MD] −2.12 days, 95% confidence interval [CI] −3.04 to −1.19 days), time to discharge from the hospital (TDH) (MD −6.43 days, 95% CI −9.53 to −3.33 days), re-intubation rate (RI) (odds ratio [OR] 0.29, 95% CI 0.22–0.39), morbidity rate (MR) (OR 0.15, 95% CI 0.08–0.30) and graft dysfunction rate (GD) (IPTE vs CTE: 0.3% vs 3.8%, P < .01), and had comparable ICU survival rate (ICUS) (OR 6.67 95% CI 1.34–33.35) when compared with CTE after LT.Conclusions:IPTE can achieve an enhanced recovery for adult patients underwent LT without additional re-intubation, morbidity, and mortality risks. However, further work needs to be done to establish the extent definitively through carefully designed and conducted RCTs.

Risk Factors for Reintubation Related to Non-Airway Failure After Liver Transplantation in Intensive Care Unit: Observational Study

“…23 Prolonged mechanical ventilation may also increase right ventricular after load and even induce venous congestion of the liver graft, especially in those with pre-existing tricuspid regurgitation and raised pulmonary artery pressures (which is not uncommon in end-stage liver disease patients). 24 When comparing the reintubated group with the non-orotracheal reintubation (Retot) group, it can be observed that the ICU time values (14 [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] days and 4 [5][6][7] days, < 0.001), mechanical ventilation time (6 [5-19] and 1 [1-3] days < 0.001) and mortality 57.9% vs. 19.1% were significantly higher in the reintubated group.…”

Fatores de Risco para Reintubação Relacionados à Insuficiência de Vias Não Aéreas Após Transplante de Fígado em Unidade de Terapia Intensiva: Estudo Observacional

“…23 A ventilação mecânica prolongada também pode aumentar após carga no ventrículo direito e até mesmo induzir a congestão venosa do enxerto hepático, especialmente naqueles com insuficiência tricúspide preexistente e pressão arterial pulmonar elevada (o que não é incomum em pacientes com doença hepática terminal). 24 Ao comparar o grupo reintubado com o grupo reintubação Agostini APRA, Boin IFSF, Heidemann A, Tonella RM, Falcão ALE, Ratti LSR, Figueiredo LC, Martins LC não orotraqueal (Retot), observa-se que os valores de tempo de UTI (14 [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] dias e 4 [5][6][7] dias, < 0,001), tempo de ventilação mecânica ( 6 [5-19] e 1 [1][2][3] dias < 0,001) e mortalidade 57,9% vs. 19,1% foram significativamente maiores no grupo reintubado.…”

Development and Performance Assessment of Novel Machine Learning Models to Predict Pneumonia&nbsp;After Liver Transplantation

“…Considering the high prevalence of multi-drug resistant bacteria in post-transplant patients induced by the excessive use of antibiotics(4), high speci city is especially necessary in clinical practice to avoid an unnecessary and overuse of antibiotics in low-risk patients. By contrast, all patients received peri-operative antibiotic therapy for 72 hr, and this has posed considerable challenge in predicting pneumonia at an early stage (23). Therefore, the novel XGBoost model as established in this study may assist clinicians in making optimal interventions and treatments, and eventually improve care for affected patients.…”