[Course and cares of intestinal transplant in immediate post-operative period]

Describe the course and immediate post-operative care in patients with intestinal transplant.

Descriptive, prospective study conducted in the Polyvalent Intensive Care Unit of a tertiary hospital for one year. Variables analyzed during the first 48 hours of the post-operative period: vital signs, O2 saturation, weaning time, diuresis, glycemia, catheters, drains, ileostomy, gastrostomy, TISS, NEMS, nursing cares, APACHE II and SAPS II on admission. Statistical analysis with SPSS 11.0.

Four patients, 50% women, mean age 42 +/- 8 years. Reason for intestinal transplant: 75% familial adenomatous polyposis with desmoid tumor and 25% mesenteric artery obstruction. They were administered alemtuzumab and tacrolimus. All the patients were carrier of central and arterial venous catheters, and Jackson Pratt abdominal drains (50% two, 50% three). Intubation time (median) 15 hours. APACHE II 10 +/- 6 y SAPS II 16 +/- 4. Means on first and second day of: systolic/diastolic blood pressure 132 +/- 23/73 +/- 11; 130 +/- 25/74 +/- 13 mmHg; glycemia 136 +/- 26/119 +/- 25 mg/dl; diuresis 95 +/- 34/125 +/- 30 cc/hour; TISS28 49 +/- 4/38 +/- 11 and NEMS 27 +/- 0/25 +/- 10, respectively. One re-operation due to hemorrhagic shock. Median study in Intensive Care Unit of 4 days.

1) They are hemodynamically stable patients with short weaning. They do not have many catheters, functioning ileostomy since the first day and TISS28 and NEMS in the middle of the range. 2) The most specific cares of the intestinal transplant are: surgical wound, drains, ileostomy, gastrostomy. 3) The need for intense immunosuppression implies strict isolation and nursing:patient ratio of 1:1.