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Risk Factors for Postoperative Prolonged Mechanical Ventilation After Pediatric Liver Transplantation
Helin Sahinturk1, Aycan Ozdemirkan, Pinar Zeyneloglu
1From the Anesthesiology and ICM Department, Baskent University Faculty of Medicine, Ankara, Turkey.
Insights
Prolonged mechanical ventilation occurred in 9.9% of pediatric liver transplant patients. Key risk factors included preoperative hepatic encephalopathy, high AST levels, and longer surgery. Mortality rates were similar regardless of ventilation duration.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Critical Care Medicine
Background:
- Prolonged mechanical ventilation post-pediatric liver transplant is linked to increased morbidity and mortality.
- Understanding the incidence and risk factors is crucial for improving outcomes.
Purpose of the Study:
- To determine the incidence of prolonged mechanical ventilation after pediatric liver transplant.
- To identify independent risk factors associated with its occurrence.
Main Methods:
- Retrospective analysis of 121 pediatric liver transplant cases (2007-2017).
- Prolonged mechanical ventilation defined as extubation after 24 hours.
- Logistic regression used to identify risk factors.
Main Results:
- 9.9% of patients required prolonged mechanical ventilation (mean 78 hours).
- Independent risk factors identified: preoperative hepatic encephalopathy, elevated AST, increased PRBC transfusion, and longer surgery duration.
- Prolonged ventilation was associated with longer ICU stay but not increased mortality.
Conclusions:
- Preoperative hepatic encephalopathy, high AST, intraoperative PRBC use, and longer surgery are significant predictors.
- These findings aid in identifying high-risk pediatric liver transplant patients needing prolonged ventilation.
Objectives:
Duration of postoperative mechanical ventilation after pediatric liver transplant may influence pulmonary functions, and postoperative prolonged mechanical ventilation is associated with higher morbidity and mortality. Here, we determined its incidence and risk factors after pediatric liver transplant at our center.
Materials And Methods:
We retrospectively analyzed the records of 121 children who underwent liver transplant between April 2007 and April 2017 (305 total liver transplant procedures were performed during this period). Prolonged mechanical ventilation was defined as postoperative tracheal extubation after 24 hours.
Results:
Mean age at transplant was 6.2 ± 5.4 years and 71/121 children (58.7%) were male. Immediate tracheal extubation was achieved in 68 children (56.2%). Postoperative prolonged mechanical ventilation was needed in 12 children (9.9%), with mean extubation time of 78.0 ± 83.4 hours. Reintubation was required in 13.4%. Logistic regression analysis revealed that presence of preoperative hepatic encephalopathy (odds ratio of 0.130; 95% confidence interval, 0.027-0.615; P = .01), high aspartate amino transferase levels (odds ratio of 1.001; 95% confidence interval, 1.000-1.002; P = .02), intraoperative usage of more packed red blood cells (odds ratio of 1.001; 95% confidence interval, 1.000-1.002; P = .04), and longer surgery duration (odds ratio of 0.723; 95% confidence interval, 0.555-0.940, P = .01) were independent risk factors for postoperative prolonged mechanical venti-lation. Although mean length of intensive care unit stay was significantly longer (12.6 ± 13.6 vs 6.0 ± 0.6 days; P = .001), mortality was similar in children with and without postoperative prolonged mechanical ventilation.
Conclusions:
Our results indicate that postoperative prolonged mechanical ventilation was needed in 9.9% of our children. Predictors of postoperative prolonged mechanical ventilation after pediatric liver transplant at our center were preoperative presence of hepatic encephalopathy, high aspartate amino transferase levels, intraoperative usage of more packed red blood cells, and longer surgery duration.
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