Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.04.006
Brazilian Journal of Anesthesiology
Original Investigation

Predictors of success of immediate tracheal extubation in living donor liver transplantation recipients

Preditores de sucesso da extubação traqueal imediata em receptores de transplante de fígado com doador vivo

Douaa G.M. Ibrahim, Gamal F. Zaki, Eman M.K. Aboseif, Dalia M.A. Elfawy, Amr M.H. Abdou

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Abstract

Background
Early tracheal extubation of recipients following liver transplantation (LT) has been gradually replacing the standard postoperative prolonged mechanical ventilation, contributing to better patient and graft survival and reduced costs. There are no universally accepted predictors of the success of immediate extubation in LT recipients. We hypothesized several potential predictors of successful immediate tracheal extubation in living donor liver transplantation (LDLT) recipients.

Aim
Evaluation of the validity of the following hypothesized factors: model for end-stage liver disease (MELD) score, duration of surgery, number of intraoperatively transfused packed red blood cells (RBCs) units, and end of surgery (EOS) serum lactate, as predictors of success of immediate tracheal extubation in living donor liver transplantation (LDLT) recipients.

Methods
In this prospective clinical investigation, perioperative data of adult living donor liver transplantation (LDLT) recipients were recorded. “Immediate extubation” was defined as tracheal extubation immediately and up to 1 hour post-transplant in the operating room. Patients were divided into the extubated group who were successfully extubated with no need for reintubation, and the non-extubated group who failed to meet the criteria of extubation, or were re-intubated within 4 hours of extubation.

Results
We enrolled 64 patients candidates for LDLT; 50 patients (76.9%) in group 1 were extubated early after LDLT while 14 patients (23.07%) in group 2 were transferred to the intensive care unit intubated. After data analysis, we found that EOS serum lactate, duration of surgery and number of packed RBCs units transfused intraoperatively were good predictors of success of immediate extubation (p < 0.001). MELD scores did not show any significant impact on the results (p = 0.54). Other factors such as EOS urine output and blood gases indices were shown to have a significant effect on the decision of extubation (p = 0.03 and 0.006, respectively).

Conclusions
EOS serum lactate, duration of surgery and number of packed RBCs units transfused were potential predictors of post-transplant early extubation.

Keywords

Living donors,  Liver transplantation,  Tracheal extubation

Resumo

Fundamento: A extubação traqueal precoce de receptores após transplante hepático (TH) vem substituindo gradativamente a ventilação mecânica prolongada pós-operatória padrão, contribuindo para melhor sobrevida do paciente e do enxerto e redução de custos. Não há preditores universalmente aceitos do sucesso da extubação imediata em receptores de TH. Nós levantamos a hipótese de vários preditores potenciais de extubação traqueal imediata bem-sucedida em receptores de transplante de fígado de doador vivo (THDV). Objetivo: Avaliar a validade dos seguintes fatores hipotetizados: modelo para escore de doença hepática terminal (MELD), duração da cirurgia, número de unidades de concentrado de hemácias (CH) transfundidas no intraoperatório e lactato sérico no final da cirurgia (FDC) , como preditores de sucesso da extubação traqueal imediata em receptores de transplante de fígado com doador vivo (THDV). Métodos: Nesta investigação clínica prospectiva, foram registrados dados perioperatórios de receptores de transplante de fígado de doador vivo adulto (THDV). “Extubação imediata” foi definida como extubação traqueal imediatamente e até 1 hora pós-transplante na sala de cirurgia. Os pacientes foram divididos em grupo extubado que foi extubado com sucesso sem necessidade de reintubação e grupo não extubado que não atendeu aos critérios de extubação ou foi reintubado dentro de 4 horas após a extubação. Resultados: Inscrevemos 64 pacientes candidatos ao THDV; 50 pacientes (76,9%) do grupo 1 foram extubados precocemente após THDV, enquanto 14 pacientes (23,07%) do grupo 2 foram transferidos para a unidade de terapia intensiva intubados. Após a análise dos dados, descobrimos que o lactato sérico FDC, a duração da cirurgia e o número de unidades de concentrado de hemácias transfundidas no intraoperatório foram bons preditores de sucesso da extubação imediata (p < 0,001). Os escores MELD não apresentaram impacto significativo nos resultados (p=0,54). Outros fatores, como débito urinário FDC e índices de gases sanguíneos, mostraram ter um efeito significativo na decisão de extubação (p=0,03 e 0,006, respectivamente). Conclusões: O lactato sérico FDC, a duração da cirurgia e o número de unidades de concentrado de hemácias transfundidas foram potenciais preditores de extubação precoce pós-transplante.

Palavras-chave

Doadores vivos; Transplante de fígado; Extubação traqueal.

References

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