Early extubation in low-risk liver transplant recipients: a quality improvement project

Increasing evidence supports early extubation in liver transplant (LT) recipients and the early recovery after surgery for LT guideline strongly recommends considering early extubation. Usual care at our institution involves admitting all LT recipients to the intensive care unit (ICU), sedated, mechanically ventilated and extubated during daytime hours. This quality improvement project aimed to identify and extubate suitable LT recipients within 4 hours postoperatively.

Baseline data were collected from all LT recipients between October 2018 and September 2020, the control group. An early extubation pathway was implemented in October 2020, and prospective data were collected from October 2020 to September 2022 and used as the intervention group. Primary outcome was extubation within 4 hours after LT. Secondary outcomes included the duration of mechanical ventilation, ICU length of stay (LOS) and hospital LOS.

During the study period, 342 LT procedures were performed, of which 339 patients were included in the study. Of LT recipients who met criteria for early extubation, the rate of extubation within 4 hours postoperatively increased from 23% (14/60) in the control group to 65% (62/96) in the intervention group (p<0.001). In adjusted models, the pathway was associated with an increased proportion of patients extubated within 4 hours (OR=6.74, 95% CI 3.04 to 14.92, p<0.001) and reduction in duration of mechanical ventilation (HR=1.95, 95% CI 1.37 to 2.79, p<0.001), ICU LOS (HR=1.42, 95% CI 1.02 to 1.99, p=0.04) and hospital LOS (HR=1.60, 95% CI 1.14 to 2.26, p=0.007).

An early extubation pathway for LT recipients reduced duration of mechanical ventilation, ICU LOS and hospital LOS.