Korean J Anesthesiol.  2014 Aug;67(2):103-109. 10.4097/kjae.2014.67.2.103.

Intraoperative predictors of early tracheal extubation after living-donor liver transplantation

• Lee S
• Sa GJ
• Kim SY
• Park CS

• KMID: 2227411
• DOI: http://doi.org/10.4097/kjae.2014.67.2.103

Abstract

BACKGROUND
Prolonged 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.
METHODS
Perioperative 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.
RESULTS
Of 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 < or = 7.0 units and last serum lactate of < or = 8.2 mmol/L were selected as predictors of early extubation after LDLT (AUC 0.865).
CONCLUSIONS
Intraoperative 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.

Keyword

Living donors; Liver transplantation; Tracheal extubation

MeSH Terms

Adult
Airway Extubation*
Ascites
Blood Transfusion
Erythrocytes
Hepatic Encephalopathy
Humans
Incidence
Intensive Care Units
Lactic Acid
Liver Diseases
Liver Transplantation*
Living Donors
Logistic Models
Lung Diseases
Multivariate Analysis
Operating Rooms
Operative Time
Reoperation
Respiration, Artificial
ROC Curve
Thrombosis
Lactic Acid