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 24 January 2018

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News

Predicting which liver transplant patients will need ventilatory support after surgery

Sole reliance on physician judgment to determine suitability for post-operative extubation leads to unnecessary use of post-operative cardiopulmonary support, suggests a study in the journal Liver Transplantation.

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As reported on GastroHep.com earlier in the week, researchers from the University of Colorado Health Sciences Center, Denver, Colorado, USA, examined whether immediate post-operative extubation and direct transfer to the surgical ward is safe and reduces reliance on the intensive care unit in most liver transplant recipient patients (see this story).

In an accompanying paper, the same authors also present data they have collected on the relationship between peri-operative patient attributes and extubation outcome.

The research group carried out the study on patients entered into their immediate post-operative extubation study from 1996 to 1998.

They carried out the study because there is no method to pre-operatively predict which patients will need ventilatory support after surgery.

The influences of 13 peri-operative and 6 intra-operative factors on extubation outcome were assessed.

The pre-operative attributes included the sex and race of the patient, their diagnosis, United Network for Organ Sharing status, Child-Pugh score, presence of a portosystemic shunt, encephalopathy, coagulation, and age.

"Physicians are conservative in extubating immediately after surgery."
Liver Transplantation

In addition, body mass index (BMI), creatinine level, and year of surgery were also recorded.

Intra-operative variables that the research group noted were type of surgery, surgeon, anesthesiologist, number of red blood cells administered, length of surgery, and surgical start time.

It was found that female sex, a BMI of 32 or greater, presence of a portosystemic shunt, and encephalopathy, were all associated with no attempt by the physician to extubate.

The presence of encephalopathy in a patient and a BMI of 34 or greater, were both factors that excluded subjects from meeting the criteria for post-operative extubation.

Commenting on these findings, report co-author Dr M. Susan Mandell said they conclude that there are limited factors that predict an increased risk for post-operative respiratory failure in liver transplant recipients.

She added, "Our results indicate that physicians are conservative in their approach to extubation immediately after surgery, and sole reliance on physician judgment to determine suitability for post-operative extubation leads to unnecessary use of post-operative cardiopulmonary support."

Liver Transplant 2002; 8(8): 682-687
08 August 2002

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