Intraoperative predictors of early tracheal extubation after living-donor liver transplantation
BackgroundProlonged mechanical ventilation after liver transplantation has been associated with deleterious clinical outcomes, so early tracheal extubation posttransplant is now increasing. However, there is no universal clinical criterion for predicting early extubation in living-donor liver transp...
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| Format: | Article |
| Language: | English |
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Korean Society of Anesthesiologists
2014-08-01
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| Series: | Korean Journal of Anesthesiology |
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| Online Access: | http://ekja.org/upload/pdf/kjae-67-103.pdf |
| _version_ | 1819229117643489280 |
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| author | Serin Lee Gye Jeol Sa Stephanie Youna Kim Chul Soo Park |
| author_facet | Serin Lee Gye Jeol Sa Stephanie Youna Kim Chul Soo Park |
| author_sort | Serin Lee |
| collection | DOAJ |
| description | BackgroundProlonged mechanical ventilation after liver transplantation has been associated with deleterious clinical outcomes, so early tracheal extubation posttransplant is now increasing. However, there is no universal clinical criterion for predicting early extubation in living-donor liver transplantation (LDLT). We investigated specific predictors of early extubation after LDLT.MethodsPerioperative data of adult patients undergoing LDLT were reviewed. "Early" extubation was defined as tracheal extubation in the operating room or intensive care unit (ICU) within 1 h posttransplant, and we divided patients into early extubation (EX) and non-EX groups. Potentially significant (P < 0.10) perioperative variables from univariate analyses were entered into multivariate logistic regression analyses. Individual cut-offs of the predictors were calculated by area under the receiver operating characteristic curve (AUC) analysis.ResultsOf 107 patients, 66 (61.7%) were extubated early after LDLT. Patients in the EX group showed shorter stays in the hospital and ICU and lower incidences of reoperation, infection, and vascular thrombosis. Preoperatively, model for end-stage liver disease score, lung disease, hepatic encephalopathy, ascites, and intraoperatively, surgical time, transfusion of packed red blood cell (PRBC), urine output, vasopressors, and last measured serum lactate were associated with early extubation (P < 0.05). After multivariate analysis, only PRBC transfusion of ≤ 7.0 units and last serum lactate of ≤ 8.2 mmol/L were selected as predictors of early extubation after LDLT (AUC 0.865).ConclusionsIntraoperative serum lactate and blood transfusion were predictors of posttransplant early extubation. Aggressive efforts to ameliorate intraoperative circulatory issues would facilitate successful early extubation after LDLT. |
| first_indexed | 2024-12-23T11:08:05Z |
| format | Article |
| id | doaj.art-76d564e17de447cf8d5f2217071847d9 |
| institution | Directory Open Access Journal |
| issn | 2005-6419 2005-7563 |
| language | English |
| last_indexed | 2024-12-23T11:08:05Z |
| publishDate | 2014-08-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Korean Journal of Anesthesiology |
| spelling | doaj.art-76d564e17de447cf8d5f2217071847d92022-12-21T17:49:25ZengKorean Society of AnesthesiologistsKorean Journal of Anesthesiology2005-64192005-75632014-08-0167210310910.4097/kjae.2014.67.2.1037900Intraoperative predictors of early tracheal extubation after living-donor liver transplantationSerin Lee0Gye Jeol Sa1Stephanie Youna Kim2Chul Soo Park3Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.BackgroundProlonged mechanical ventilation after liver transplantation has been associated with deleterious clinical outcomes, so early tracheal extubation posttransplant is now increasing. However, there is no universal clinical criterion for predicting early extubation in living-donor liver transplantation (LDLT). We investigated specific predictors of early extubation after LDLT.MethodsPerioperative data of adult patients undergoing LDLT were reviewed. "Early" extubation was defined as tracheal extubation in the operating room or intensive care unit (ICU) within 1 h posttransplant, and we divided patients into early extubation (EX) and non-EX groups. Potentially significant (P < 0.10) perioperative variables from univariate analyses were entered into multivariate logistic regression analyses. Individual cut-offs of the predictors were calculated by area under the receiver operating characteristic curve (AUC) analysis.ResultsOf 107 patients, 66 (61.7%) were extubated early after LDLT. Patients in the EX group showed shorter stays in the hospital and ICU and lower incidences of reoperation, infection, and vascular thrombosis. Preoperatively, model for end-stage liver disease score, lung disease, hepatic encephalopathy, ascites, and intraoperatively, surgical time, transfusion of packed red blood cell (PRBC), urine output, vasopressors, and last measured serum lactate were associated with early extubation (P < 0.05). After multivariate analysis, only PRBC transfusion of ≤ 7.0 units and last serum lactate of ≤ 8.2 mmol/L were selected as predictors of early extubation after LDLT (AUC 0.865).ConclusionsIntraoperative serum lactate and blood transfusion were predictors of posttransplant early extubation. Aggressive efforts to ameliorate intraoperative circulatory issues would facilitate successful early extubation after LDLT.http://ekja.org/upload/pdf/kjae-67-103.pdfliving donorsliver transplantationtracheal extubation |
| spellingShingle | Serin Lee Gye Jeol Sa Stephanie Youna Kim Chul Soo Park Intraoperative predictors of early tracheal extubation after living-donor liver transplantation Korean Journal of Anesthesiology living donors liver transplantation tracheal extubation |
| title | Intraoperative predictors of early tracheal extubation after living-donor liver transplantation |
| title_full | Intraoperative predictors of early tracheal extubation after living-donor liver transplantation |
| title_fullStr | Intraoperative predictors of early tracheal extubation after living-donor liver transplantation |
| title_full_unstemmed | Intraoperative predictors of early tracheal extubation after living-donor liver transplantation |
| title_short | Intraoperative predictors of early tracheal extubation after living-donor liver transplantation |
| title_sort | intraoperative predictors of early tracheal extubation after living donor liver transplantation |
| topic | living donors liver transplantation tracheal extubation |
| url | http://ekja.org/upload/pdf/kjae-67-103.pdf |
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