Immediate tracheal extubation of the liver transplant recipients in the operating room

Ulukaya, Sezgin; Ayanoglu, H.O; Acar, Levent; Tokat, Yaman; Kılıç, Murat

doi:10.1016/s0041-1345(02)03670-9

Cited by 15 publications

(17 citation statements)

References 6 publications

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“…This may be explained by the larger proportion of patients in whom the abdominal incision could not be closed at the time of surgery in the recent period (20%) compared to old period (5.6%) ( Table 4 ) and to the younger age of patients in the recent group. The case series that describes early extubation in children post-OLT were mainly but not only in older children [ 21 ]. Furthermore early extubation involves different anesthetic techniques which were not used in our patients [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

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Early Critical Care Course in Children after Liver Transplant

Kukreti

Daoud

Bola

et al. 2014

Critical Care Research and Practice

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Objective. To review the critical care course of children receiving orthotopic liver transplantation (OLT). Methods. A retrospective chart review of patients admitted to the pediatric critical care following OLT performed in our center between 1988 and 2011. Results. A total of 149 transplants in 145 patients with a median age of 2.7 (IQR 0.9–7) years were analyzed. Mortality in the first 28 days was 8%. The median length of stay (LOS) was 7 (4.0–12.0) days. The median length of mechanical ventilation (MV) was 3 (1.0–6.2) days. Open abdomen, age, and oxygenation index on the 2nd day predicted LOS. Open abdomen, age, amount of blood transfused during surgery, and PRISM III predicted length of MV. 28% of patients had infection and 24% developed acute rejection. In recent group (2000–2011) OLT was performed in younger patients; the risk of infection and acute rejection was reduced and patients required longer LOS and MV compared with old group (1988–1999). Conclusion. The postoperative course of children after OLT is associated with multiple complications. In recent years OLT was performed in younger children; living donors were more common; the rate of postoperative infection and suspected rejection was reduced significantly; however patients required longer MV and LOS in the PCCU.

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Section: Discussionmentioning

confidence: 99%

“…The case series that describes early extubation in children post-OLT were mainly but not only in older children [ 21 ]. Furthermore early extubation involves different anesthetic techniques which were not used in our patients [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Early Critical Care Course in Children after Liver Transplant

Kukreti

Daoud

Bola

et al. 2014

Critical Care Research and Practice

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“…After screening titles and abstracts, we retrieved 138 reports for full-text screening and then excluded 123 ones for no useable data (n = 68), improper study design (n = 45), overlapping data (n = 1) [ 19 ] and conference abstracts (n = 9). Finally, a total of 15 studies, including 10 retrospective ones, [ 9 , 20 – 28 ] 1 prospective one [ 29 ] and 4 case series [ 2 , 30 – 32 ] were eligible for inclusion (Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…1 ). A total number of 4144 patients were recruited, including 3387 patients from 10 studies [ 9 , 20 – 28 ] for quantitative synthesis and 757 patients from 5 studies [ 2 , 29 – 32 ] for qualitative synthesis (Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

Immediate versus conventional postoperative tracheal extubation for enhanced recovery after liver transplantation

Li¹,

Wang

Jiang³

et al. 2018

Medicine

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Introduction:To systematically compare immediate postoperative tracheal extubation (IPTE) with conventional tracheal extubation (CTE) and to determine whether IPTE can achieve an enhanced recovery for adult patients underwent liver transplantation (LT) without additional risks. We designed a systematic review and meta-analysis.Methods:The RCTs, cohorts, case–controls, or case series that explored outcomes of IPTE after LT for adults were involved in our study. The Newcastle–Ottawa scale was used to assess the risk of bias.Results:A total of 15 studies (n = 4144) were included, consisting of 10 studies (retrospective cohorts; n = 3387) for quantitative synthesis and 5 studies (1 prospective cohort, and 4 case series; n = 757) for qualitative synthesis. The pooled estimates suggested IPTE could reduce time to discharge from ICU stay (TDICU) (mean difference [MD] −2.12 days, 95% confidence interval [CI] −3.04 to −1.19 days), time to discharge from the hospital (TDH) (MD −6.43 days, 95% CI −9.53 to −3.33 days), re-intubation rate (RI) (odds ratio [OR] 0.29, 95% CI 0.22–0.39), morbidity rate (MR) (OR 0.15, 95% CI 0.08–0.30) and graft dysfunction rate (GD) (IPTE vs CTE: 0.3% vs 3.8%, P < .01), and had comparable ICU survival rate (ICUS) (OR 6.67 95% CI 1.34–33.35) when compared with CTE after LT.Conclusions:IPTE can achieve an enhanced recovery for adult patients underwent LT without additional re-intubation, morbidity, and mortality risks. However, further work needs to be done to establish the extent definitively through carefully designed and conducted RCTs.

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“…This approach was associated to be safe for the recipient, without any increased incidence for reintubation [13,14,23], and is applicable for both the pediatric liver transplantation as well as the living-related liver donation [12,16,24]. Further advantage is the reduction in the costs due to the decreased utilization of intensive capacities, which are noted in an American study to be approximately 13% of the total costs of a liver transplantation [25].…”

Section: Discussionmentioning

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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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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Immediate tracheal extubation of the liver transplant recipients in the operating room

Cited by 15 publications

References 6 publications

Early Critical Care Course in Children after Liver Transplant

Early Critical Care Course in Children after Liver Transplant

Immediate versus conventional postoperative tracheal extubation for enhanced recovery after liver transplantation

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

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