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Published on: August 2, 2024
Predictors of Immediate Tracheal Extubation in the Operating Room After Pediatric Liver Transplantation
Aytekin Ünlükaplan1, Adnan Torgay, Arash Pirat
1From the Department of Anesthesiology, Acibadem Maslak Hospital, Istanbul, Turkey.
Insights
Pediatric liver transplant patients needing mechanical ventilation post-surgery were identified. Growth failure and high intraoperative lactate levels predict the need for mechanical ventilation in these children.
Area of Science:
- Pediatric Surgery
- Critical Care Medicine
- Hepatology
Background:
- Mechanical ventilation is common in pediatric liver transplant recipients.
- Limited intensive care unit (ICU) beds necessitate predicting ventilation needs.
- Early extubation may reduce complications and improve outcomes.
Purpose of the Study:
- To identify predictors of mechanical ventilation requirement in pediatric orthotopic liver transplant patients.
- To inform clinical decisions regarding postoperative respiratory support.
Main Methods:
- Retrospective analysis of 57 pediatric liver transplant cases.
- Patients categorized based on need for postoperative mechanical ventilation.
- Data collected included demographics, comorbidities, perioperative values, and intraoperative parameters.
Main Results:
- 46% of patients required mechanical ventilation.
- Growth failure, higher intraoperative lactate, and increased use of blood products/vasopressors were associated with ventilation need.
- Multivariate analysis identified growth failure (OR=37) and elevated intraoperative lactate (OR=1.5) as significant predictors.
Conclusions:
- Growth failure and elevated intraoperative lactate levels are key predictors for postoperative mechanical ventilation in pediatric liver transplant recipients.
- These findings can aid in resource allocation and patient management.
Objectives:
Pediatric orthotopic liver transplant recipients frequently need mechanical ventilation during the immediate posttransplant period. However, intensive care unit beds are costly and scarce; therefore, anticipating which patients will require postoperative mechanical ventilation support is important. In addition, immediate postoperative extubation may reduce the incidence of postoperative respiratory complications and improve patient outcomes after orthotopic liver transplant. Here, we aimed to determine the predictors of need for mechanical ventilation after orthotopic liver transplant in pediatric patients.
Materials And Methods:
We retrospectively analyzed the records of 57 pediatric patients who underwent orthotopic liver transplant (performed by the same team at Baskent University Hospital from April 1996 to August 2009). Patients were divided into 2 groups according to whether they required postoperative mechanical ventilation or not. Collected data included demographic features; comorbidities; cause of liver failure; perioperative laboratory values; intraoperative hemodynamic parameters; use and volume of crystalloids, colloids, and blood products; albumin levels; portal vein clamping time, requirement of inotropes/vasopressors; and anesthesia duration.
Results:
Mean age and body weight of patients were 25.0 ± 23.1 months and 10.8 ± 5.3 kg, respectively. Of 57 patients, 26 (46%) needed postoperative mechanical ventilation. Compared with those who did not require postoperative mechanical ventilation, patients who required mechanical ventilation had growth failure (P = .03), higher mean intraoperative lactate level (P = .03), and higher mean intraoperative fresh frozen plasma/erythrocyte suspension (P = .049) and intraoperative vasopressor (P = .022) requirements. Multivariate logistic regression analysis revealed that growth failure (odds ratio = 37; P = .03) and higher intraoperative lactate level (odds ratio = 1.5; P = .03) were predictors of the need for mechanical ventilation.
Conclusions:
About 46% of our pediatric orthotopic liver transplant recipients required mechanical ventilation postoperatively. Growth failure and higher intraoperative lactate levels were associated with need for postoperative mechanical ventilation.
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