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Intraoperative fluid administration volumes during pediatric liver transplantation and postoperative outcomes: A
Proshad N Efune1,2, Matthew J Hoyt3, Rita Saynhalath1,2
1Division of Pediatric Anesthesia, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Insights
Intraoperative fluid administration shows a weak correlation with the duration of mechanical ventilation after pediatric liver transplants. Further research into other modifiable factors is needed to improve outcomes for these vulnerable patients.
Area of Science:
- Pediatric Surgery
- Transplant Medicine
- Critical Care Medicine
Background:
- Fluid administration is crucial in pediatric liver transplantation and can influence patient outcomes.
- Understanding the impact of intraoperative fluid volume on postoperative recovery is essential.
Purpose of the Study:
- To assess the association between intraoperative fluid administration volume and the duration of postoperative mechanical ventilation in children undergoing liver transplantation.
- To explore secondary outcomes including intensive care unit (ICU) and hospital length of stay.
Main Methods:
- A multicenter, retrospective cohort study involving 286 pediatric liver transplants.
- Intraoperative fluid administration was indexed to patient weight and anesthesia duration.
- Univariate and stepwise linear regression analyses were performed to determine correlations.
Main Results:
- A weak correlation was found between intraoperative fluid administration and the duration of postoperative mechanical ventilation (r² = .161, p = .04).
- Other significant factors influencing ventilation duration included transplant center and the use of an open abdominal incision post-transplant.
- Median ventilation duration was 10.8 hours, ICU stay was 4.3 days, and hospital stay was 13.6 days.
Conclusions:
- Intraoperative fluid administration has a limited, weak correlation with the duration of mechanical ventilation post-pediatric liver transplant.
- Exploring other modifiable factors is necessary to enhance postoperative outcomes in pediatric liver transplant recipients.
Introduction:
Fluid administration is an important aspect of the management of children undergoing liver transplantation and may impact postoperative outcomes. Our aim was to evaluate the association between volume of intraoperative fluid administration and our primary outcome, the duration of postoperative mechanical ventilation following pediatric liver transplantation. Secondary outcomes included intensive care unit length of stay and hospital length of stay.
Methods:
We conducted a multicenter, retrospective cohort study using electronic data from three major pediatric liver transplant centers. Intraoperative fluid administration was indexed to weight and duration of anesthesia. Univariate and stepwise linear regression analyses were conducted.
Results:
Among 286 successful pediatric liver transplants, the median duration of postoperative mechanical ventilation was 10.8 h (IQR 0.0, 35.4), the median intensive care unit length of stay was 4.3 days (IQR 2.7, 6.8), and the median hospital length of stay was 13.6 days (9.8, 21.1). Univariate linear regression showed a weak correlation between intraoperative fluids and duration of ventilation (r2 = .037, p = .001). Following stepwise linear regression, intraoperative fluid administration remained weakly correlated (r2 = .161, p = .04) with duration of postoperative ventilation. The following variables were also independently correlated with duration of ventilation: center (Riley Children's Health versus Children's Health Dallas, p = .001), and open abdominal incision after transplant (p = .001).
Discussion:
The amount of intraoperative fluid administration is correlated with duration of postoperative mechanical ventilation in children undergoing liver transplantation, however, it does not seem to be a strong factor.
Conclusions:
Other modifiable factors should be sought which may lead to improved postoperative outcomes in this highly vulnerable patient population.
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