Immediate Tracheal Extubation After Pediatric Liver Transplantation

Şahintürk, Helin; Özdemirkan, Aycan; Yılmaz, Olcay; Zeyneloğlu, Pınar; Pirat, Arash; Haberal, Mehmet

doi:10.6002/ect.2018.0067

Cited by 14 publications

(42 citation statements)

References 21 publications

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“…Recipients who successfully underwent IE had a significantly shorter ICU and hospital length of stay in our series, as has been described in previous adult and pediatric reports 1–3,6–9 . By performing a multivariable linear regression for length of stay, however, we were able to demonstrate that IE itself is not independently associated with shorter ICU and hospital length of stay, but rather may be a proxy for lower disease severity and better clinical status.…”

Section: Discussionsupporting

confidence: 80%

“…Although several previous studies have described baseline differences in recipient, donor, and intraoperative characteristics between pediatric liver transplant recipients with IE and DE, this is one of the first to identify independent risk factors against IE using a multivariable logistic regression model that accounts for confounding effects. [6][7][8][9][10][11] Our data suggest that recipients who are younger than 2 years, had respiratory failure prior to their transplant, and/or required high amounts of pressor support intraoperatively are unlikely to be immediately extubated, while the majority of recipients without these risk factors can be safely and successfully extubated in the OR. These data may be used to develop standardized protocols for IE following pediatric liver transplantation and guide preoperative family counseling regarding the likelihood of IE.…”

Section: Discussionmentioning

confidence: 79%

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Immediate extubation following pediatric liver transplantation

Yoeli

Nguyen

Wilder

et al. 2022

Pediatric Transplantation

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Background Immediate extubation (IE) following pediatric liver transplantation is being increasingly performed. The aim of this study was to characterize the rate of IE at our institution and identify recipient factors predictive of IE. Methods All pediatric liver transplants performed at our institution between January 1, 2015 and December 31, 2020 were reviewed. Retransplants and multi‐organ transplants were excluded. IE was defined as extubation in the operating room following transplant. Backward stepwise logistic regression at a p‐value threshold of .05 was performed to identify variables associated with IE. Results IE was achieved in 58 (72%) of the 81 pediatric liver transplants. The IE cohort had significantly shorter ICU length of stay and overall hospital length of stay, though IE was not an independent predictor of posttransplant length of stay. Age <2 years, preoperative mechanical ventilation, and total intraoperative epinephrine and dopamine infusion requirements were significant, independent risk factors against IE. This multivariable model was highly predictive of IE (area under the curve = 0.89). Conclusions We describe the highest rate of IE postpediatric liver transplantation that has been reported to date and identified significant risk factors against successful IE.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 79%

Immediate extubation following pediatric liver transplantation

Yoeli

Nguyen

Wilder

et al. 2022

Pediatric Transplantation

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“…Some of previous studies used bolus morphine 10 or infusion morphine 12 for postoperative pain management, others did not specify. 1,11 We used paracetamol and intermittent boluses of Fentanyl for postoperative pain management.…”

Section: Discussionmentioning

confidence: 99%

“…Immediate extubation (IE) has been described in pediatric liver transplant for over 2 decades now, but it is still not widely practiced. Evidence is increasing for immediate extubation of pediatric liver transplant patients in operating room (OR) with different groups reporting success rates varying between 30% to 58% 1 . Fast tracking with extubation soon after cardiac surgery in pediatric patients is considered an important quality improvement initiative 2 .…”

Section: Introductionmentioning

confidence: 99%

Safety and feasibility of immediate tracheal extubation of small pediatric patients after living donor liver transplantation

Pandey

Prabhudesai

Goyal

et al. 2022

Pediatric Transplantation

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Background Immediate extubation is integral constituent of enhance recovery protocols. Purpose of this study was to examine success rates and safety of protocolized immediate extubation in pediatric living donor liver transplant recipients and to find out factors associated with non‐immediate extubation in operation room. Methods We performed retrospective analysis for data of small (≤20 kg) pediatric patients transplanted between 2017 and 2019 (protocolized duration) and compared with data of transplants done between 2014 and 2016 (non‐protocolized duration). Further, we compared data during each time duration between immediate extubation and non‐immediate extubation group to find risk factors in that particular duration. Results Immediate extubation rates were significantly higher during protocolized duration compared with non‐protocolized duration (85.52% vs. 48.29%, p < .001). Reintubation rates decreased during protocolized duration (10.9% vs. 4.6%). Hospital stays (20.47 ± 7.06 vs. 27.8 ± 6.2 days, p < .001) and mortality (13.2% vs. 28%, p = .04) were significantly decreased in protocolized duration. Higher age (OR: 2.85, 95% CI 1.22–6.67, p = .02), weight > 10 (OR: 4.37, 95% CI 1.16–16.46, p = .029) and high vasopressor support (OR: 32, 95% CI 6.4–160.13, p < .001) found as significant predictors of non‐immediate extubation however only high vasopressor support found to be independent predictor during protocolized duration. Conclusions Outcomes in pediatric transplants can be optimized by immediate extubation in majority of cases when protocolized as part of policy.

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“…In reviewing the demographic data for the general and liver a Data presented using chi-square test; however, given low frequency of events, Fishers' exact test also performed with p = .12. and pediatric liver transplant populations. [6][7][8][9][10][11] Recently, several pediatric groups have shared their data regarding early extubation after liver transplantation with excellent outcomes, including extubation rates of 67%, 12 58%, 13 48%, 14 and 54%. 15 Here, we report the highest immediate extubation rate of 80% for patients cared for by our liver team in 2017-2020, an increase from our rate of 56% for patients cared for by the general team in 2013-2016, with no patients in either group requiring reintubation.…”

Section: Discussionmentioning

confidence: 99%

Outcomes following formation of a dedicated pediatric liver transplant anesthesia team

Drobish

Reina

Nieva

et al. 2022

Pediatric Anesthesia

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Background: Given the complex nature of liver transplant surgery, adult centers typically use a dedicated liver transplant anesthesia team, which has improved patient outcomes.Aims: Our goal was to determine whether a dedicated pediatric liver transplant anesthesia team was associated with improved patient outcomes. Methods: This retrospective cohort study analyzed patients who underwent liver transplantation from April 2013 to September 2020 at St. Louis Children's Hospital. The general group (April 2013-December 2016) was compared with the liver group (January 2017-September 2020). Outcomes measured included cases per anesthesiologist, early extubation, ventilator days, fluid and blood administration, postoperative events, and intensive care unit and hospital length of stay (LOS).Results: Patients in both groups had similar demographics. The average number of cases/anesthesiologist/year was 2.9 times higher in the liver group (mean (SD) general 0.7 (0.5), liver 2.0 (0.6), and difference in mean [95% CI] 1.3 [0.8, 1.8]). The rate of extubation in the operating room was higher for patients in the liver group (general 56%, liver 80%, and difference in proportion [95% CI] 24.7 [7.0, 42.4]), while the number of ventilator days was lower (mean (SD) general 2.1 (4.4), liver 1.1 (3.6), and difference in proportion [95%CI] −0.9 [−2.6, 0.7]). Colloid administration was higher in the liver group (mean (SD) general 23.9 (14.5) ml/kg, liver 48.4 (37.7) ml/kg, and difference in mean [95% CI] 24. 6 [12.7, 36.4]), while fresh frozen plasma administration was lower in the liver group (mean (SD) general 15.3 (23.9) ml/kg, liver 6.2 (14) ml/kg, and difference in mean [95% CI] −9.0 [−16.8, −1.3]). There were no significant differences between the groups in postoperative events including blood product transfusions, vasopressor use, and thromboses, or in the intensive care unit and hospital LOS. Conclusions:The liver group was associated with increased early extubations, decreased ventilator days, and decreased fresh frozen plasma use.

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Immediate Tracheal Extubation After Pediatric Liver Transplantation

Cited by 14 publications

References 21 publications

Immediate extubation following pediatric liver transplantation

Immediate extubation following pediatric liver transplantation

Safety and feasibility of immediate tracheal extubation of small pediatric patients after living donor liver transplantation

Outcomes following formation of a dedicated pediatric liver transplant anesthesia team

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