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Fast track in liver transplantation: 5 years' experience
G Biancofiore1, M L Bindi, A M Romanelli
1Cisanello Hospital, Postsurgical and Transplantation ICU, Department of Anaesthesia and Critical Care, Italy. g.biancofiore@med.unipi.it
European Journal of Anaesthesiology
|August 27, 2005
Summary
Immediate tracheal extubation after liver transplantation is feasible in over half of patients. This practice, driven by anaesthetist confidence and experience, can improve perioperative care quality.
Area of Science:
- Anesthesiology
- Transplant Surgery
- Critical Care Medicine
Background:
- Reducing postoperative mechanical ventilation in liver transplant recipients offers clinical and organizational benefits.
- This study evaluates the feasibility of immediate tracheal extubation in the operating theatre post-liver transplantation.
Purpose of the Study:
- To assess the possibility and outcomes of immediate tracheal extubation in liver transplant patients.
- To identify factors influencing the success rate of early extubation.
Main Methods:
- Prospective study of 354 liver transplant patients from June 1999 to May 2004.
- Standardized criteria for immediate extubation in the operating theatre, focusing on hemodynamic and metabolic stability.
Main Results:
- 58.5% (207/354) of patients were extubated immediately; only two required re-intubation.
- The rate of immediate extubation increased to 82.5% by the study's final year.
- Model for End-stage Liver Disease (MELD) score < 11 predicted successful rapid extubation (AUC=0.61, P<0.05).
Conclusions:
- Immediate extubation after liver transplantation is achievable in a significant proportion of patients.
- Anaesthetist confidence, habit, and emulation are key to wider adoption.
- Successful immediate extubation can serve as a perioperative quality indicator in liver transplantation.