Dolores Villar, PA-C
Physician Assistant
Mayo Clinic Hospital in Florida
Jacksonville, Florida
Disclosure information not submitted.
Stephanie Carmon, APRN
Nurse Practitioner
Mayo Clinic Hospital in Florida, United States
Disclosure information not submitted.
philip Lowman, MD
Doctor of Medicine
Mayo Clinic, United States
Disclosure information not submitted.
Christan Santos, MSN, FNP-BC
Nurse Practitioner
Mayo Clinic Hospital in Florida
Jacksonville, Florida
Disclosure information not submitted.
Title: Fast Track Extubation for Liver Transplant Patients Admitted to ICU Postoperatively
Introduction: Early extubation following orthotopic liver transplantation (OLT) has grown substantially in the last three decades, with several centers bypassing admission to the intensive care unit (ICU). However, there is a sparsity of data regarding timing of extubation for OLT patients who require postoperative ICU admission. This retrospective analysis investigated one academic center’s practice of extubating post-OLT ICU patients over one year.
Methods: After IRB approval, we conducted a retrospective analysis of the electronic medical record from October 2019 to October 2020 for post-OLT ICU admissions. The primary endpoint was extubation time following ICU admission. The secondary endpoint was reintubation within 48 hours of extubation along with causation. Covariates of interest included the presence of pulmonary hypertension (PH), portopulmonary hypertension (PoPH), hepatopulmonary syndrome (HPS), intraoperative red blood cell (RBC) transfusion count, and type of allograft. Exclusion criteria included combined organ transplants, simultaneous bariatric surgery, primary nonfunction (PNF), intraoperative cardiac arrest, admitted to ICU with open abdomen (OA), and preoperative respiratory failure.
Results: Over one year, 76 patients were admitted to the ICU post-OLT. Of those patients, 31 were excluded due to: combined organ transplantation (12, 15.8%), bariatric surgery (6, 7.9%), preoperative respiratory failure (4, 5.3%), PNF (3, 3.9%), cardiac arrest (3, 3.9%), and OA (1, 1.3%). Of the remaining 45 patients, 2 (4.4%) had HPS, 4 (5.7%) had PoPH, and 2 (4.4%) had PH. The mean extubation time was 11.3 hours (median 7.5 hours). Reasons for reintubations within 48 hours (8, 17.8%) included: return to operating room (4, 5.7%), respiratory distress (4, 5.7%), and gastrointestinal bleeding (2, 2.8%). The majority of patients (37, 82.2%) received a donation by brain death (DBD) allograft. The mean intraoperative RBC count was 8.4 units.
Conclusion: Our data demonstrated that 71% of patients were extubated within 12 hours of ICU admission. Limitations for this study include small sample size and single institution study. This preliminary evidence supports a larger scale study with the intent of developing a fast-track extubation protocol for post-OLT ICU patients.