Immediate Tracheal Extubation After Pediatric Liver Transplantation
| Autor: | Adnan Torgay, Pinar Zeyneloglu, Mehmet Haberal, Olcay Yilmaz, Arash Pirat, Aycan Ozdemirkan, Helin Sahinturk |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_treatment Liver transplantation law.invention Tracheal extubation law medicine Humans Lactic Acid Child Open abdomen Retrospective Studies Transplantation business.industry Medical record Length of Stay University hospital Intensive care unit Liver Transplantation Massive blood transfusion Treatment Outcome Anesthesia Child Preschool Airway Extubation Female Packed red blood cells business |
| Zdroj: | Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 19(10) |
| ISSN: | 2146-8427 |
| Popis: | OBJECTIVES We examined whether immediate tracheal extubation among pediatric liver transplant recipients was safe and feasible. MATERIALS AND METHODS We retrospectively analyzed medical records of pediatric liver transplant recipients at Baskent University Hospital from January 2012 to December 2017. We grouped children who were extubated in the operating room versus those extubated in the intensive care unit. RESULTS In our study group of 81 pediatric patients, median age was 4 years (range, 4 mo to 16 y) and 44 (54%) were male. Immediate tracheal extubation in the operating room was performed in 39 patients (48%). Children who remained intubated (n = 42) had more frequent massive hemorrhage (14% vs 0%; P = .015), received larger amounts of packed red blood cells (19.3 vs 10.2 mL/kg; P < .001), and had higher serum lactate levels (9.0 vs 6.9 mmol/L; P = .001) intraoperatively. All children with open abdomens postoperatively remained intubated (n = 7). Patients extubated in the operating room received less vasopressors (1 [3%] vs 12 [29%]; P = .002) and antibiotics (11 [28%] vs 22 [52%]; P = 0.041) and developed infections less frequently postoperatively (3.0 [8%] vs 15.0 [36%]; P = .003). Children extubated in the operating room had shorter mean stay in the intensive care unit (2.0 vs 4.5 days; P < .001). Hospital mortality was higher in children who remained intubated (12% vs 0%; P = .026). CONCLUSIONS Immediate tracheal extubation was well tolerated in almost half of our patients and did not compromise their outcomes. Patients who remained intubated had longer intensive care unit stays and higher hospital mortalities. Therefore, we recommend immediate tracheal extubation in the operating room after pediatric liver transplant among those children without intraoperative requirements for massive blood transfusion, high-dose vasopressors, high serum lactate levels, and open abdomen. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|