Fast track in liver transplantation

Biancofiore, Gianni; Bindi, Massimo; Am, Romanelli; Boldrini, A; Bisà, M; Esposito, Massimo; Urbani, Lucio; Catalano, G; Mosca, Franco; Filipponi, Franco

doi:10.1017/s0265021505000980

Cited by 90 publications

(103 citation statements)

References 18 publications

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“…Donor organs damaged due to cooling and transportation can therefore recuperate much faster from the so-called preservation damage, a factor which contributes significantly towards the recovery of the recipient [11,22]. In this regard, Biancofiore et al reported on significantly lower mortality rates of recipients who were extubated in the operating theatre (1%) compared to recipients with primary extubation within the first 24 hours postoperatively (4%) and those with ventilation times of over 24 hours (42%) [14].…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, in numerous transplant centers the extubation time-However, in spite of all these advantages not all patients profit from the fast tracking concept. The rate of extubation in the operating theatre is currently approximately 80%, which implies that still about one fifth of all patients in intensive care unit receive artificial ventilation [5,8,12,[14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Failure of Immediate Tracheal Extubation After Liver Transplantation - A Single Center Experience

Hoffmeister¹,

Stange²,

Neumann³

et al. 2008

TOSJ

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Fast tracking approaches in liver transplantation include postoperative extubation immediately after surgery in the operating theatre. Based on the experience of 837 liver transplantations performed between 01/97 and 05/05, we report on the safety and feasibility of this procedure in almost 80% of transplant recipients, without increasing the incidence of subsequent reintubation (11%). This patient population experienced significantly higher survival compared to patients in whom extubation succeeded at the intensive care unit (p<0.02). Special attention was required for recipients with acute liver failure or retransplantation. These patients did not participate in fast tracking protocols, as demonstrated by a multivariate regression analysis. In this context, failure of immediate tracheal extubation was independent of cold ischemic time, duration of surgery, donor / recipient age or gender, extent of preservation injury, or type of organ donation (postmortal vs living-related). ROC analysis revealed that only intraoperative transfusions of 6 units of red blood cells were associated with primary extubation in the operating theatre with high sensitivity and specifity. To conclude, postoperative mechanical ventilation is justified only in a small cohort of recipients. For the vast majority of patients, immediate postoperative tracheal extubation should be the standard procedure after liver transplantation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Failure of Immediate Tracheal Extubation After Liver Transplantation - A Single Center Experience

Hoffmeister¹,

Stange²,

Neumann³

et al. 2008

TOSJ

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“…Uygun hastalarda gerçekleştirilen erken ekstübasyonun greft fonksiyonunu iyileştirdiği, YBÜ'de kalış süresini ve maliyeti azalttığı, nozokomiyal enfeksiyon oranını düşürdüğü gösterilmiştir. Erken ekstübasyon için hastaların seçiminin cerrahi süresine, transfüze edilen kan ürünlerinin miktarına, hastanın preoperatif durumuna (MELD skoru), greftin durumu ve iskemi süresine bağlı olduğu gösterilmiştir (86)(87)(88).…”

Section: Pulmoner Sorunlar Ve Solunumsal Yönetimunclassified

Critical Care Management after Adult Liver Transplantation

Akan¹

2017

tybdd

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1ÖZ Karaciğer transplantasyonu uygulanan hastaların yoğun bakım yönetimi çok yönlü bir izlemi ve multidisipliner bir yaklaşımı gerektirir. Günümüzde ideal bir yoğun bakım tedavisi için deneyimli bir ekibe ve gelişmiş yoğun bakım/hastane olanaklarına gereksinim vardır. Karaciğer transplantasyon olgularının postoperatif yoğun bakım yönetimi zaman içinde hızlı bir gelişme göstermiştir. Preoperatif optimizasyon, cerrahi teknik, intraoperatif anestezi yönetimi, organ prezervasyonu, yoğun bakım ve immünosüpresyon tedavilerindeki gelişmeler ile 1998'de %79 düzeyinde olan karaciğer transplantasyonu sonrası bir yıllık sağkalım 2008'de %90'a yükselmiştir. Karaciğer transplantasyonlu olguların yoğun bakım yönetiminde özellikle hızlı kardiyorespiratuvar stabilizasyon, ağır koagülopatinin düzeltilmesi, mekanik ventilasyondan erken ayırma, uygun sıvı-elektrolit tedavisi, böbrek fonksiyonlarının korunması, greft rejeksiyonun önlenmesi ve enfeksiyon profilaksisi/tedavisi büyük önem taşır. Erken postoperatif dönem çok hassas bir süreç olduğundan yakın monitörizasyon, kardiyorespiratuvar fonksiyonların stabilizasyonu, greft fonksiyonunun sık değerlendirilmesi, komplikasyonların erken tanınması ve ekstrahepatik organ yetersizliklerinin hızlı tedavisi mortalite/morbiditenin azaltılabilmesi için zorunludur. Anahtar Kelimeler: Karaciğer transplantasyonu, postoperatif dönem, yoğun bakım, karaciğer yetersizliği ABSTRACT Critical care management after liver transplantation requires a sophisticated monitoring and multi-disciplinary team work. An experienced team and advanced critical care/hospital facilities are necessary for an ideal critical care treatment today. Critical care management after liver transplantation has shown a rapid development since the introduction of liver transplantation. While one-year survival rate after liver transplantation was 79% in 1998, it raised to 90% in 2008 related to the improvements in preoperative optimization, surgical technique, anesthetic management, organ preservation, critial care and immunosuppressive treatment. Treatment of severe coagulopathy, prompt hemodynamic and respiratory stabilization, early weaning from mechanical ventilation, proper fluid-electrolyte therapy, prevention of graft rejection, protection of renal functions and prophylaxis/treatment of infection are particularly important in critical care management after liver transplantation. As early postoperative period of liver transplantation is a critical phase; close monitoring, stabilization of cardiopulmonary functions, frequent evaluation of graft function, early diagnosis of complications and rapid treatment of extrahepatic organ failure are mandatory in order to reduce mortality/morbidity.

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“…In recent years there is a gradual increase in the number of early extubated recipients approaching to approximately 70-80% (Forraz-Neto et al, 1999;Park et al, 2000;Biancofiore et al, 2005;Salizzoni et al, 2005). Postoperative positive airway pressure ventilation combined with sedation has been known to decrease surgical stress response, improve haemodynamic stability and facilitate early recovery; however leading to elevated intrathoracic pressures it causes an increase in pulmonary vascular resistance which in turn rises right ventricular afterload.…”

Section: Early-extubation (Fast-tracking)mentioning

confidence: 99%