Influence of early extubation on post‐operative outcomes after pediatric lung transplantation

Abstract

Lung transplantation has become an accepted therapeutic option for a select group of children with end‐stage lung disease. We evaluated the impact of early extubation in a pediatric lung transplant population and its post‐operative outcomes. Single‐center retrospective study. PICU within a tertiary academic pediatric hospital. Patients <22 years after pulmonary transplant between January 2011 and December 2016. A total of 74 patients underwent lung transplantation. The primary pretransplantation diagnoses included cystic fibrosis (58%), pulmonary fibrosis (9%), and surfactant dysfunction disorders (10%). Of 60 patients, 36 (60%) were extubated within 24 hours and 24 patients after 24 hours (40%). A total of seven patients (11.6%) required reintubation within 24 hours. Median length of stay for the early extubation group was shorter at 3 days ([(IQR) 2.2‐4.7]) compared to 5 days (IQR, 3‐7) (P = .02) in the late extubation group. Median costs were lower for the early extubation group with 13,833 US dollars (IQR, 9980‐22,822) vs 23 671 US dollars (IQR, 16 673‐39 267) (P = .043). Fourteen patients were in the PICU prior to their transplantation; this did not affect their early extubation success. Neither did the fact of requiring invasive or non‐invasive mechanical ventilation before transplantation. Early extubation appears to be safe in a pediatric population after lung transplantation and is associated with a shorter LOS and decreased hospital costs. It may prevent known complications associated with mechanical ventilation.

Highlights from the 12th congress of the international pediatric transplant association, Austin, Texas 2023

“…Preoperative and intra operative predictors of early extubation included older age, shorter length of surgery, low‐volume transfusions of packed red cells and fresh frozen plasma, and utilization of regional anesthesia. The early extubation group demonstrated a decreased in ICU and hospital length of stay 9 …”

“…Early extubation after liver transplant surgery has been demonstrated in pilot studies. Maudarbaccus et al presented 23/192 children over a 7‐year period who were extubated in the operating room and none of them required reintubation in ICU 9 . Preoperative and intra operative predictors of early extubation included older age, shorter length of surgery, low‐volume transfusions of packed red cells and fresh frozen plasma, and utilization of regional anesthesia.…”

“…Maudarbaccus et al presented 23/192 children over a 7year period who were extubated in the operating room and none of them required reintubation in ICU. 9 Preoperative and intra operative predictors of early extubation included older age, shorter length of surgery, low-volume transfusions of packed red cells and fresh frozen plasma, and utilization of regional anesthesia. The early extubation group demonstrated a decreased in ICU and hospital length of stay.…”