Postoperative ventilation and admission to the intensive care unit (ICU) is the standard of care in liver transplantation and comprises a significant proportion of transplantation costs.
Because immediate postoperative extubation has been reported previously in a selected group of liver transplant recipients, researchers from the University of Colorado Health Sciences Center, Denver, Colorado, USA, questioned whether this protocol could be extended to a larger group of patients.
In addition, Dr M. Susan Mandell and colleagues sought to determine what proportion of patients extubated immediately following surgery could be transferred to the surgical ward without intervening ICU care.
Using a prospective trial of sequential liver transplant recipients, the research group identified 147 patients who were not second-transplant recipients, United Network for Organ Sharing 1, liver donor transplant recipients, or dead before the end of surgery.
| Early extubation protocol:|
Reduced ICU stay by 1 day in 75.5% of cases
| Liver Transplantation|
Of these 147 patients, 13 did not meet post-surgical criteria for early extubation, while 111 were successfully extubated.
Following routine admission to the post-operative care unit, 83 extubated patients were transferred to the surgical ward.
Only 3 who were transferred to this ward experienced complications that required a greater intensity of nursing care.
During the 3-year study period, attempts to extubate increased from 73% to 96% and triage to the surgical ward increased from 52% to 82% without compromising patient safety.
The use of this protocol in the study center resulted in a 1-day reduction in ICU use in 75.5% of study subjects.
"The majority of liver transplant recipients can be extubated safely and admitted to the surgical ward after liver transplantation surgery, thus decreasing the cost associated with ICU care", said Dr Mandell.