Postoperative tracheal extubation after orthotopic liver transplantation

Glanemann, Matthias; Langrehr, J. M.; Kaisers, Udo; Schenk, R; Müller, A.R; Stange, Barbara; Neumann, Ulf; Bechstein, Wolf O.; Falke, K. J.; Neuhaus, P.

doi:10.1034/j.1399-6576.2001.045003333.x

Cited by 91 publications

(80 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…After transplantation, patients were allowed to breathe spontaneously, and no anesthetic drugs were administered, so as to achieve extubation as soon as possible (21).…”

Section: Patientsmentioning

confidence: 99%

Clinical Implications of Hepatic Preservation Injury After Adult Liver Transplantation

Glanemann

Langrehr

Stange

et al. 2003

American Journal of Transplantation

View full text Add to dashboard Cite

Several advances in organ preservation have allowed for improved results after liver transplantation; however, little information is available regarding the clinical impact of preservation injury on the postoperative course. The medical records of 889 liver transplants were retrospectively reviewed. Preservation injury was classified according to postoperative aspartate aminotransferase values as minor (<1000 U/L), moderate (1000–5000 U/L), or severe (>5000 U/L). The following criteria were analyzed and compared according to the extent of preservation injury: patient and graft survival, retransplantation rate, duration of hospitalization and postoperative ventilation, as well as incidence of rejection, infection, and hemodialysis. The majority of patients received a liver with minor preservation injury (75.9%), whereas 22.7% and 1.3% of grafts showed moderate or severe injury. Graft survival was significantly lower in patients with severe preservation injury, when compared to minor or moderate injury. The relative risk for initial nonfunction was 39.36‐fold increased (95% confidence interval (ci): 10.3–150.2), as it was increased for duration of postoperative ventilation (6.92‐fold; 95%ci: 2.1–22.3) and hemodialysis (6.13‐fold; 95%ci: 1.9–19.3). Since the incidence of retransplantation was significantly increased (50%), patient survival remained comparable between all groups. Severe preservation injury had a tremendous impact on the postoperative clinical course, requiring the maximum medical effort to achieve adequate patient survival.

show abstract

“…After transplantation, patients were allowed to breathe spontaneously, and no anesthetic drugs were administered, so as to achieve extubation as soon as possible (21).…”

Section: Patientsmentioning

confidence: 99%

Clinical Implications of Hepatic Preservation Injury After Adult Liver Transplantation

Glanemann

Langrehr

Stange

et al. 2003

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…Previous studies have identified pleural effusion as the most frequent respiratory complication after orthotopic liver transplant. 4,7 After intra-abdominal operations, pleural effusions may enlarge over the first postoperative week but typically resolve by the third week. 8 The effusion, if allowed stand for a long time, may get infected leading to empyema, and this will be mortal in patients with immunodeficiency.…”

Section: Discussionmentioning

confidence: 99%

“…However, in every stage of the transplant, infections remain a common life-threatening complication despite prophylactic strategies. 3,4 Infectious and noninfectious pulmonary complications can cause prolonged ventilatory support. Pleural effusion, acute respiratory failure, pulmonary edema, alveolar hemorrhage, and acute respiratory distress syndrome are pulmonary complications that can be encountered after liver transplant.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2014

Exp Clin Transplant

View full text Add to dashboard Cite

Objectives: Pulmonary complications are a leading problem after a liver transplant. This study sought to predict postoperative early complications by a chest radiograph performed after a transplant among adult orthotopic liver transplant recipients. Materials and Methods: One hundred thirty-five patients (43 women, 92 men; mean age, 40 y; range, 16-66 y) were included and their medical data reviewed retrospectively. A postoperative chest radiograph of each patient was evaluated to check for pulmonary complications. Results: Smoking history was noted in 61 patients (45.2%). Postoperative first chest radiograph evaluation showed normal findings in 56 patients (41.5%). Right pleural effusion was found in 25 patients (18.5%), and atelectasis was found in 25 (18.5%). Bilateral pleural effusion was the second most-frequent finding on postoperative radiograph (14.8%). Effusion accompanied by atelectasis was found in 3 patients (2.2%). Other postoperative chest radiograph findings were consolidation (n=2, 1.5%), left pleural effusion (n=2, 1.5%), and bronchiectasis (n=2, 1.5%). Conclusions: We investigated the reflection of the first chest radiograph after liver transplant on postoperative early complications. Postoperative first chest radiograph can be an inexpensive and accessible diagnostic tool for predicting postoperative problems. Key words: Chest radiograph, Pleural effusion, Postoperative IntroductionLiver transplant is a successful treatment for patients with acute liver failure and end-stage liver cirrhosis. Postoperative complications of a transplant require unique and intensive management approach. Early detection and management of complications can reduce the risk of morbidity and mortality. In the first month course after transplant, surgical complications, graft dysfunction, and infections are the most common problems. 1,2 Pulmonary complications also are one of the leading problems after a liver transplant. Complications and their results vary depending on the time after a transplant. However, in every stage of the transplant, infections remain a common life-threatening complication despite prophylactic strategies. 3,4 Infectious and noninfectious pulmonary complications can cause prolonged ventilatory support. Pleural effusion, acute respiratory failure, pulmonary edema, alveolar hemorrhage, and acute respiratory distress syndrome are pulmonary complications that can be encountered after liver transplant. This study sought to predict postoperative early complications by first chest radiograph performed after transplant among adult orthotopic liver transplant recipients. Materials and Methods Study populationOne hundred thirty-five patients (43 women, 92 men; mean age, 40 y; range, 16-66 y) were included and their medical data reviewed retrospectively. The smoking status, other demographics, mortality, and rejection within a month after transplant were noted. Preoperative pulmonary clinical status also was

show abstract

“…More recently, Glanemann et al and Biancofiore et al achieved immediate or very early (Ͻ3 hours) extubation in patients after liver transplantation without an increase in the incidence of reintubation compared with patients in whom extubation occurred later. 8,9 Although encouraging, none of these studies were conducted in a randomized, prospective manner.…”

Section: Discussionmentioning

confidence: 99%

Fast track anesthesia for liver transplantation reduces postoperative ventilation time but not intensive care unit stay

Findlay¹

2002

Liver Transplantation

View full text Add to dashboard Cite

Fast tracking is an approach to health care delivery that emphasizes the efficient use of resources. This investigation was designed to determine whether shorter-acting drugs and different drug administration practices reduce the length of time for which patients require mechanical ventilation and intensive care after liver transplantation. After obtaining Institutional Review Board approval and informed consent, we randomized 80 consecutive patients (>17 years) undergoing liver transplantation to receive either our traditional anesthetic (thiopental, pancuronium, 50 g/kg fentanyl), or fast track anesthetic (propofol, cisatracurium, 20 g/kg fentanyl). The patients were weaned to extubation in the intensive care unit after an established clinical protocol. Measured data included the occurrence of intraoperative hypotension, intraoperative hypertension, intraoperative tachycardia, the length of postoperative mechanical ventilation, length of intensive care unit stay, and episodes of reintubation. Seventy-eight patients remained in the study through the investigation (two died intraoperatively). Operating time; amount of intraoperative red blood cells transfused; lowest body temperature achieved; and minutes of intraoperative hypotension, hypertension, and tachycardia were not different between the traditional and fast track patient groups. Postoperative ventilation time was greater in the patients who received the traditional anesthetic; mean. 1,081 minutes (median, 855) versus mean, 553.5 minutes (median, 390) (P < .001). However, there was no difference in length of intensive care unit stay. Five patients required reintubation (two patients given the traditional anesthetic, three given the fast track anesthetic). We conclude that a fast track approach to anesthetic care reduces the requirement for postoperative mechanical ventilation, but does not reduce intensive care unit stay after liver transplantation. F ast tracking is an approach to health care delivery that emphasizes efficient use of resources. Fast tracking uses critical pathways or in-hospital care mapping to efficiently sequence the care of patients. Tools being used in fast tracking include the application of short-acting medications and early extubation techniques. Inherent in these strategies is the attempt to reduce or completely avoid time spent in centers of high cost, especially the intensive care unit (ICU).Fast track anesthesia has been used in cardiac surgery for over two decades. 1 Several investigators have documented a reduction in resource expenditures in coronary artery bypass patients who received early extubation or had care delivered by fast track and/or critical pathway techniques. [2][3][4][5] Mandell et al applied these methods to orthotopic liver transplantation (OLTx) and found that patients who were extubated before ICU admission had a reduced length of stay in the ICU, decreased need for certain ICU services, and overall lower ICU costs. 6 In 1996, to streamline the care of liver transplant patients at our institution, we dev...

show abstract

Postoperative tracheal extubation after orthotopic liver transplantation

Cited by 91 publications

References 29 publications

Clinical Implications of Hepatic Preservation Injury After Adult Liver Transplantation

Clinical Implications of Hepatic Preservation Injury After Adult Liver Transplantation

Untitled

Fast track anesthesia for liver transplantation reduces postoperative ventilation time but not intensive care unit stay

Contact Info

Product

Resources

About