Postoperative Tracheal Extubation after Pediatric Liver Transplantation

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Abstract

Introduction

The duration of postoperative mechanical ventilation after pediatric liver transplantation may influence pulmonary functions and prolonged postoperative mechanical ventilation (PPMV) is associated with higher morbidity and mortality. The aim of the study was to determine the incidence and risk factors for PPMV after pediatric liver transplantation (LT).

Material and Methods

We retrospectively analyzed the records of children who underwent liver transplantation between April 2007 to April 2017. Prolonged mechanical ventilation was defined as postoperative tracheal extubation after 24 hours.

Results and Discussion

A total of 121 children underwent LT. The mean age at transplantation was 6.2 ± 5.4 years and 71 (58.7%) were male. Immediate tracheal extubation at the operating room was achieved in 68 (56.2%) of children. PPMV was needed in 12 (9.9%) of them and the mean time of extubation was 78.0 ± 83.4 hours. The incidence of reintubation was 13.4%. Logistic regression analysis revealed that presence of preoperative hepatic encephalopathy (odds ratio (OR), 0.130; 95% confidence interval (CI), 0.027-0.615; p=.01), high AST levels (OR, 1.001; 95%CI, 1.000-1.002; p=.02 ); intraoperative usage of more packed red blood cells (OR, 1.001; 95%CI, 1.000-1.002; p=.04) and longer duration of surgery (OR, 0.723; 95%CI, 0.555-0.940, p=.01) were independent risk factors for PPMV. The mean length of ICU stay is significantly longer in children with PPMV (12.6 ± 13.6 days vs 6.0 ± 0.6 days, p=.001). Mortality was similar in children with and without PPMV.

Conclusion

Our results indicate that immediate tracheal extubation was performed in more than half of our pediatric liver transplant recipients. However, PPMV was needed in 9.9% of our children. Predictors of PPMV after pediatric LT were preoperative presence of hepatic encephalopathy, high AST levels and intraoperative usage of more packed red blood cells and longer duration of surgery.

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