Immediate postoperative extubation after liver transplantation at our centre: A report of two cases

Aneja, Sanjeev; Raina, Raman

doi:10.4103/0019-5049.84861

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…Hence, experience with only a few cases of FT LDLT recipients has been published so far. [ 11 12 ] The small proportion of FT recipients in our high-volume centre confirms this difficulty with LDLT recipients.…”

Section: Discussionmentioning

confidence: 64%

Fast tracking in adult living donor liver transplantation: A case series of 15 patients

Bhangui

Gupta

et al. 2018

Indian J Anaesth

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Background and Aims:Fast tracking (FT) for more efficacious use of resources may be difficult after living donor liver transplantation (LDLT) due to a partial liver graft, complex vascular anastomoses and longer operating time. Our study was aimed at reporting our experience with FT (on table extubation) in LDLT recipients. A secondary objective of our study was to look at defining a subgroup of patients who could be prospectively planned for FT.Methods:We studied the demographics and outcomes of 15 LDLT recipients extubated immediately in the operating suite based on an uneventful intraoperative course, haemodynamic stability after graft reperfusion and improvement of metabolic parameters post-implantation and vascular anastomoses.Results:Twelve recipients were males, and mean age, body mass index (BMI) and Model for End Stage Liver Disease (MELD) score were 43 ± 12 years, 23 ± 3 kg/m2 and 15.5 ± 6, respectively, most were Child–Turcotte–Pugh Class B. Diabetes and hypothyroidism were present in 1 and 2 patients, respectively. Post-extubation, none required immediate re-intubation and one patient needed non-invasive ventilation for 2 h.Conclusion:Fast tracked recipients were young, with a low BMI, low MELD scores, minimal comorbidities and good immediate graft function post-reperfusion.

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Section: Discussionmentioning

confidence: 64%

Fast tracking in adult living donor liver transplantation: A case series of 15 patients

Bhangui

Gupta

et al. 2018

Indian J Anaesth

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“…In the 1980s, early endotracheal extubation in the operating room (E-OR) was first applied in cardiac surgery, and later in liver transplantation (8,9). E-OR can decrease the costs and the complications associated with mechanical ventilation such as hemodynamic instability, pulmonary colonization of gastrointestinal micro-organisms, sepsis, risks of barotrauma, and bronchial anastomosis leaks caused by the need for sedatives or opioids to inhibit gastrointestinal motility (10).…”

Section: Original Articlementioning

confidence: 99%

Early extubation in operating room after single-lung transplantation: a single institutional experience

Ai¹,

Deng²,

Danxia³

et al. 2021

Ann Palliat Med

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Background: Early endotracheal extubation in operating room (E-OR) after lung transplantation is rarely reported worldwide. Herein, we aim to explore the feasibility and safety of E-OR after lung transplantation and demonstrate its potential benefits.Methods: This study is a single-center retrospective database analysis of 18 patients. All lung transplantation patients with E-OR attempted between June 2018 and September 2019 were included retrospectively. Perioperative variables, including ischemia time, total blood loss, blood lactic acid, the partial pressure of oxygen, partial pressure of oxygen/fraction of inspiration oxygen ratio, time of semi-open pulmonary artery occlusion clamp, extubation rate, and complications after E-OR, were analyzed. Data were compared using non-parametric tests and expressed as the median or number (percentage).Results: Clinical data of 18 patients with E-OR attempted were collected. Overall, 15/18 (83.33%) patients successfully underwent E-OR without reintubation. Reintubation occurred in 3/18 (16.67%) patients; one patient presented with decreased blood oxygen saturation and unconsciousness, while two patients developed hypoxemia and respiratory failure after E-OR. Extracorporeal membrane oxygenation (ECMO) was not used postoperatively. No grade 3 primary graft dysfunction was observed and all eighteen patients were alive 1 year after the transplant. No postoperative hemodialysis and tracheotomy occurred. The median length of stay in the intensive care unit (ICU) for E-OR patients was 120 hours, the median length of postoperative hospital stay was 19 days, and the median hospitalization cost was 35,577 USD.Conclusions: Early endotracheal extubation in operating room was feasible and did not delay postoperative recovery in these 18 lung transplantation recipients.

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“…Studies have shown that postoperative pulmonary rehabilitation can improve the activity endurance of patients after lung transplantation, improve lung function, and effectively r e d u c e p o s t o p e r a t i v e c o m p l i c a t i o n s ( 7 , 8 ). E a r l y endotracheal extubation is firstly used in 1980s in cardiac and liver surgery (9). Early endotracheal could reduce the cost and ventilation associated complications (10).…”

Section: Introductionmentioning

confidence: 99%

The effect of early tracheal extubation combined with physical training on pulmonary rehabilitation of patients after lung transplantation: a randomized controlled trial

Wu¹,

Zhou²,

Wu³

et al. 2022

J Thorac Dis

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Background: This study aimed to explore the effect of early extubation combined with physical training on pulmonary rehabilitation of patients after lung transplantation. Methods: This is an open parallel randomized controlled trial. A total of 96 lung transplant patients admitted to Wuxi People's Hospital (July 2018 to June 2019) were included. Inclusion criteria: (I) aged 18-75; (II) lung transplantation; (III) communicate normally; (IV) voluntary participation. According to the random number method, they were divided into the control group (routine nursing intervention) and the observation group (early extubation combined with a physical training program). The indwelling tracheal intubation time, discharge time, intensive care unit (ICU) stay time, lung function, 6 Minutes Walk Distance (6MWD), Modified Barthel Index (MBI) and satisfaction rate were recorded and analyzed. Results:The observation group's first-time postoperative ambulation (t=2.10, P=0.039), indwelling tracheal intubation time (Z=2.864, P=0.004), and discharge time (t=3.111, P<0.001) were shorter than the control group, while the difference of ICU stay time was not statistically significant (Z=−1.658, P=0.097).Before treatment, there was no significant difference in the lung function, 6MWD, and MBI of the two groups (P>0.05). After treatment, the Forced Expiratory Volume In 1 s (FEV1)% (t=−2.707, P<0.001), forced vital capacity (FVC)% (t=−3.716, P<0.001), FEV1/FVC (t=−3.539, P<0.001), 6MWD (t=−5.567, P<0.001), and MBI indexes (t=−4.073, P<0.001) were better than in observation group. The satisfaction rate of the observation group was better than the control group (P<0.05).Conclusions: For lung transplant recipients, early extubation combined with a physical training program is scientific, safe, and feasible. This approach is helpful to promote the postoperative recovery of lung transplant patients, reduce the length of hospitalization, help patients improve their lung function and ability to engage in activities of daily living, and increase the satisfaction rate of postoperative recovery. Results show that the combination of early extubation and a physical training program is worthy of clinical promotion for lung transplant recipients.

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Immediate postoperative extubation after liver transplantation at our centre: A report of two cases

Cited by 5 publications

References 5 publications

Fast tracking in adult living donor liver transplantation: A case series of 15 patients

Fast tracking in adult living donor liver transplantation: A case series of 15 patients

Early extubation in operating room after single-lung transplantation: a single institutional experience

The effect of early tracheal extubation combined with physical training on pulmonary rehabilitation of patients after lung transplantation: a randomized controlled trial

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