Predictors of success of immediate tracheal extubation in living donor liver transplantation recipients

Ibrahim, Douaa G.M.; Zaki, Gamal Fouad Saleh; Aboseif, Eman M.K.; Elfawy, Dalia M; Abdou, Amr M Hilal

doi:10.1016/j.bjane.2021.04.006

Cited by 6 publications

(5 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our study, we observed that higher intraoperative lactate levels are a risk factor for NIE after LT. Unlukaplan et al. reported similar findings, identifying higher mean intraoperative lactate levels are a risk factor for non‐IE after pediatric LT 10 . Additionally, Sahintruk et al.…”

Section: Discussionmentioning

confidence: 70%

Criteria for immediate extubation after pediatric liver transplantation in a single pediatric liver transplant center in Japan

Baba,

Ninagawa,

Uranaka

et al. 2023

Clinical Transplantation

View full text Add to dashboard Cite

Immediate extubation (IE) following liver transplantation (LT) has become the standard practice, even for pediatric patients. However, no preoperative or postoperative case selection protocols for IE are currently available. We have developed selection criteria for IE following pediatric LT. The aim of this study is to assess the safety and effectiveness of these selection criteria and anesthetic management protocol implemented in our hospital for IE after pediatric LT.MethodThis was a retrospective study. The records of all cases undergoing LT in our center from January 2016 to December 2020 were collected. We excluded cases > 18 years old at the time of LT. Enrolled cases were divided into two groups: cases with immediate extubation (IE) or without immediate extubation (NIE). We compared preoperative conditions, intraoperative management, and postoperative courses. Finally, we classified NIE group patients into cases extubated at postoperative day 1 (early; E‐NIE) and others (delayed; D‐NIE) and compared their underlying diseases and postoperative courses.ResultsIn the IE group, there were 81 cases, while the NIE group consisted of 185 cases. All patients in the IE group were successfully extubated without any instances of re‐intubation due to respiratory failure. Within the E‐NIE group, comprising 130 cases, all patients were ultimately extubated without the need for tracheostomy. However, in the D‐NIE group, which encompassed 53 cases, seven patients required tracheostomy.ConclusionIn our center, the implementation of our anesthesia management protocol and the use of pre/postoperative case selection criteria have allowed for the safe practice of IE following pediatric LT. However, it should be noted that patients who cannot be extubated by Postoperative Day 1 (POD1) may be at an increased risk of requiring a tracheostomy. When contemplating IE, it is crucial to take into account the disease‐specific physiological aspects and surgical site situations.

show abstract

Section: Discussionmentioning

confidence: 70%

Criteria for immediate extubation after pediatric liver transplantation in a single pediatric liver transplant center in Japan

Baba,

Ninagawa,

Uranaka

et al. 2023

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…In addition to genetic factors, an elevated serum lactate level and the application of intraoperative CRRT had a significant effect on the occurrence of PMV. Serum lactate levels have especially been emphasized as a good predictor for delayed endotracheal extubation among liver transplantation recipients [ 37 ]. It has also been highlighted as a significant risk factor for increasing the postoperative risk of morbidity and mortality [ 38 ] and prolonging the length of hospital stay [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Association of HLA-DPA1 gene polymorphism with prolonged mechanical ventilation in patients undergoing liver transplantation

Kim¹,

Kim²,

Kim³

et al. 2022

Korean J Anesthesiol

View full text Add to dashboard Cite

Background Prolonged mechanical ventilation (PMV) is a common complication after liver transplantation surgery. However, owing to the clinical and economic benefits of early extubation, many efforts have been used to assess the clinical predictors for PMV. The aim of our study was to explore the impact of perioperative risk factors, including candidate gene polymorphisms, for PMV in patients undergoing liver transplantation. Methods One hundred forty patients who underwent liver transplantation surgery were enrolled. The duration of mechanical ventilation after surgery was examined, along with the length of intensive care unit and hospital stay, and 30-day mortality. Patient-related clinical factors and single nucleotide polymorphisms of candidate genes were assessed with regard to PMV, which was defined as mechanical ventilation for > 48 h. Results Twenty-six (19%) patients continued to receive mechanical ventilation at 48 h after surgery. Intraoperative continuous renal replacement therapy (CRRT) and an elevated serum lactate level during the postoperative period were significantly associated with the PMV group, compared to the non-PMV group (odds ratio [OR] = 24.731 [1.077, 567.915] versus OR = 3.008 [1.497, 6.045]). A significant association existed between the HLA-DPA1 rs8486 polymorphism and the risk of PMV under the allele model (OR = 8.060 [1.451, 44.765]). Conclusions The rs8486 polymorphism in HLA-DPA1 can independently affect the risk of PMV in liver transplantation recipients, along with intraoperative CRRT application, and elevated lactate level during the postoperative period.

show abstract

“…Even with protocols using defined physiological and lab criteria, individual provider experience was found to be a major contributor to increased rates of early extubation, with increased success rates as providers became comfortable with the idea of early extubation [20,31,32]. While early extubation has been shown to be safe in living-donor liver transplant recipients [33,34], there are no studies evaluating "fast-track" anesthesia in this population. Presumably this is due to the small number of programs with fast-track processes in place.…”

Section: Historymentioning

confidence: 99%

The Practice of Fast-Track Liver Transplant Anesthesia

Aniskevich

Scott

Ladlie

2023

JCM

View full text Add to dashboard Cite

Prior to the 1990s, prolonged postoperative intubation and admission to the intensive care unit was considered the standard of care following liver transplantation. Advocates of this practice speculated that this time allowed patients to recover from the stress of major surgery and allowed their clinicians to optimize the recipients’ hemodynamics. As evidence in the cardiac surgical literature on the feasibility of early extubation grew, clinicians began applying these principles to liver transplant recipients. Further, some centers also began challenging the dogma that patients need to be cared for in the intensive care unit following liver transplantation and instead transferred patients to the floor or stepdown units immediately following surgery, a technique known as “fast-track” liver transplantation. This article aims to provide a history of early extubation for liver transplant recipients and offer practical advice on how to select patients that may be able to bypass the intensive care unit and be recovered in a non-traditional manner.

show abstract

Predictors of success of immediate tracheal extubation in living donor liver transplantation recipients

Cited by 6 publications

References 12 publications

Criteria for immediate extubation after pediatric liver transplantation in a single pediatric liver transplant center in Japan

Criteria for immediate extubation after pediatric liver transplantation in a single pediatric liver transplant center in Japan

Association of HLA-DPA1 gene polymorphism with prolonged mechanical ventilation in patients undergoing liver transplantation

The Practice of Fast-Track Liver Transplant Anesthesia

Contact Info

Product

Resources

About