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Published on: November 30, 2022
Awake prone positioning in an infant following living donor liver transplantation
Yunshan Zou1, Yingying Zhang2, Senbiao Chen3
1Department of Surgical and Transplant Intensive Care Unit, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. zouysh@mail3.sysu.edu.cn.
Insights
Early prone positioning improved oxygenation in an infant after living donor liver transplantation. This approach may be safe and effective, suggesting further investigation into its use in pediatric liver transplant recipients.
Area of Science:
- Pediatric critical care medicine
- Hepatology
- Transplantation surgery
Background:
- Prone positioning is recognized for enhancing ventilation and oxygenation in infants.
- Limited data exists on early prone positioning post-pediatric liver transplantation.
- This case explores its application to improve oxygenation in a pediatric liver transplant recipient.
Purpose of the Study:
- To evaluate the efficacy and safety of early prone position ventilation in an infant following living donor liver transplantation.
- To address respiratory failure and improve oxygenation in a complex pediatric surgical case.
Main Methods:
- An 8-month-old infant with Type II respiratory failure post-liver transplant underwent prone position ventilation after the third extubation attempt.
- Ventilation was initiated on the 11th postoperative day.
- Continuous prone positioning was maintained for two days.
Main Results:
- Prone position ventilation led to increased oxygenation without adverse effects, including no signs of liver transplant ischemia.
- Airway secretions decreased, facilitating successful extubation.
- The infant was discharged from the intensive care unit.
Conclusions:
- Early prone position ventilation appears effective and safe in select infants post-pediatric liver transplantation.
- This suggests that prone positioning is not an absolute contraindication in this patient population.
- Further research into optimal prone positioning strategies for pediatric liver transplant recipients is warranted.
Background:
Prone position has been proven to improve ventilation and oxygenation in infants. Currently, there are few reports of early prone position ventilation after pediatric liver transplantation. Here, we present our experience with prone position in an infant following living donor liver transplantation, in an attempt to improve oxygenation.
Case Presentation:
An 8-month-old boy, 7.5 kg, experienced two failed extubations that presented with Type II respiratory failure due to dyspnea, potentially caused by consolidation and airway secretions. To prevent the third failure of extubation, prone position ventilation was implemented after the third extubation on the 11th postoperative day. Oxygenation increased after each prone position session with no signs of transplant liver ischemia or other adverse outcomes. Following two days of continuous prone position, airway secretions decreased, and the infant was discharged from the ICU. The third extubation procedure was successful.
Conclusions:
Prone position ventilation may be effective in this infant without adverse events, indicating that early prone position is not absolutely contraindicated after pediatric liver transplantation. Therefore, more reasonable prone position strategies should be sought in infants undergoing liver transplantation.
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