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Orthotopic Liver Transplantation in Rats
Published on: July 1, 2012
Immediate extubation after pediatric liver transplantation: a single-center experience
Nora M Fullington1, Ryan P Cauley, Kristina M Potanos
1Departments of Surgery, Boston Children's Hospital, Boston, MA.
Insights
Pediatric liver transplant patients can often be safely extubated in the operating room. This practice led to shorter hospital stays without increasing reintubation risks, suggesting a safe alternative to traditional ventilation.
Area of Science:
- Pediatric surgery
- Transplant medicine
- Anesthesiology
Background:
- Postoperative mechanical ventilation is a standard practice for pediatric liver transplant recipients.
- A shift in practice occurred in 2005 towards immediate extubation in the operating room (OR).
Purpose of the Study:
- To evaluate the rates and safety of immediate extubation in pediatric liver transplant patients.
- To assess the impact of immediate extubation on patient outcomes.
Main Methods:
- Retrospective review of 84 pediatric liver transplant cases from 2005 to 2011.
- Analysis of immediate extubation rates and comparison with delayed extubation in the intensive care unit (ICU).
Main Results:
- The rate of immediate extubation increased significantly from 33% to 67% between two study periods.
- Immediate extubation did not lead to higher reintubation rates compared to delayed extubation.
- Patients extubated in the OR showed a trend towards shorter ICU stays and significantly shorter overall hospital stays.
Conclusions:
- Immediate extubation in the OR is a safe and effective strategy for the majority of pediatric liver transplant recipients.
- A learning curve exists for implementing this practice, but benefits include reduced hospital length of stay.
- This approach challenges traditional postoperative ventilation protocols in this patient population.
Abstract:
The care of pediatric liver transplant recipients has traditionally included postoperative mechanical ventilation. In 2005, we started extubating children undergoing liver transplantation in the operating room according to standard criteria for extubation used for general surgery cases. We reviewed our single-center experience to determine our rates of immediate extubation and practice since that time. The records of 84 children who underwent liver transplantation from 2005 to 2011 were retrospectively reviewed. The immediate extubation rate increased from 33% during 2005-2008 to 67% during 2009-2011. Immediate extubation did not result in an increased reintubation rate in comparison with delayed extubation in the intensive care unit (ICU). Patients undergoing immediate extubation had a trend toward a shorter mean ICU stay as well as a significantly decreased overall hospital length of stay. Our findings suggest that there is a learning curve for instituting immediate extubation in the operating room after liver transplantation and that the majority of pediatric liver recipients can safely undergo immediate extubation.
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