Utilization of immediate extubation in a multidisciplinary pathway for pediatric liver transplantation associated with improved postoperative outcomes

• Published in: Pediatric transplantation Vol. 28; no. 3; pp. e14722 - n/a
• Main Authors: Goldstein, Matthew A., Karlik, Joelle, Kamat, Pradip P., Lo, Denise J., Liu, Katie, Gilbertson, Laura E.
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.05.2024
• Subjects: endotracheal extubation; Extubation; Infections; Liver transplantation; Liver transplants; Mortality; Patients; pediatric anesthesia; pediatric critical care; Pediatrics; Postoperative infection; postoperative outcomes; Statistical analysis; Thrombosis; postoperative outcomes; pediatric anesthesia; pediatric critical care; liver transplantation; endotracheal extubation
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/petr.14722

Background Immediate extubation is becoming more common in liver transplantation. However, limited data exist on how to identify pediatric patients with potential for successful immediate extubation and how this intervention may affect recovery. Methods This retrospective review evaluated patients who underwent liver transplantation from 2015 to 2021 at Children's Healthcare of Atlanta. Preoperative status and intraoperative management were evaluated and compared. Outcomes comprised thrombosis, surgical reexploration, retransplantation, as well as reintubation, high flow nasal cannula (HFNC) usage, postoperative infection, the length of stay (LOS), and mortality. Results A total of 173 patients were analyzed, with 121 patients (69.9%) extubated immediately. The extubation group had older age (median 4.0 vs 1.25 years, p = .048), lower PELD/MELD (28 vs. 34, p = .03), decreased transfusion (10.2 vs. 41.7 mL/kg, p < .001), shorter surgical time (332 vs. 392 min, p < .001), and primary abdominal closure (81% vs. 40.4%, p < .001). Immediate extubation was associated with decreased HFNC (0.21 vs. 0.71 days, p = .02), postoperative infection (9.9% vs. 26.9%, p = .007), mortality (0% vs. 5.8%, p = .036), and pediatric intensive care unit LOS (4.7 vs. 11.4 days, p < .001). The complication rate was lower in the extubation group (24.8% vs. 36.5%), but not statistically significant. Conclusions Approximately 70% of patients were able to be successfully extubated immediately, with only 2.5% requiring reintubation. Those immediately extubated had decreased need for HFNC, lower infection rates, shorter LOS, and decreased mortality. Our results show that with proper patient selection and a multidisciplinary approach, immediate extubation allows for improved recovery without increased respiratory complications after pediatric liver transplantation. This retrospective review evaluated the utilization of a multidisciplinary pathway for immediate extubation in pediatric liver transplantation. Our results show that approximately 70% of patients were able to be immediately extubated, with 2.5% requiring re‐intubation. Those immediately extubated had decreased HFNC, lower infection rates, shorter LOS, and decreased mortality.