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Critical Care: Critical Care |

Factors Influencing Fast Track Extubation Following Liver Transplant Surgery: A 3 Year Mayo Clinic Experience FREE TO VIEW

Devang Sanghavi, MD; Kumar Sarvottam, MD; Rahul Kashyap, MD; Bibek Pannu, MD; Julie Heimbach, MD; Vivek Iyer, MD
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Mayo Clinic, Rochester, MN


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A150. doi:10.1016/j.chest.2016.02.156
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SESSION TITLE: Critical Care

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, April 17, 2016 at 02:15 PM - 03:45 PM

PURPOSE: Liver transplantation (LT) is a complex surgery with potential for a number of short term peri and post operative complications including bleeding, vascular compromise and hemodynamic instability. Most transplant centers utilize some kind of formal or informal approach to assess readiness for early extubation after LT. What is currently lacking in the literature is a risk predictor tool to determine which patients would be a candidate for rapid extubation. The goal of this study was to identify pre and intra-operative factors that could help identify factors associated with successful early extubation post LT.

METHODS: Retrospective analysis of all patients who underwent LT from Jan 1st 2012 to December 31th, 2014. A total of 313 patients (including pediatric subjects) comprised the study cohort. A total of 154 patients remained intubated longer than six hours (late extubation group) and 159 patients were extubated within first 6 hours post LT surgery (early extubation group). We compared the demographics, preoperative and intraoperative clinical and laboratory markers between the two groups

RESULTS: Baseline characteristics such as age, gender, MELD, MELD-Na, BMI and length of the surgery were no different between two groups (P > 0.05). On univariate analysis; coagulation parameters obtained at the end of surgery including higher INR (p= 0.03), lower platelets (p= 0.006) and lower fibrinogen (p= 0.003) were all associated with delayed extubation. Similarly intraoperative transfusion volume of RBC, platelets, FFP, autologous PRBC, cryoprecipitate, crystalloids, volume of ascitic fluid removed and low urine output were all significantly associated with delayed extubation (P <0.001). On multivariate analysis the only variable that was associated with delayed extubation was the transfusion of more than 6 units in OR (P=0.02).

CONCLUSIONS: Our data suggest that several important intra-operative variables including last intraoperative coagulation labs, intraoperative transfusion requirements, lower urine output, large volume ascitic fluid removed and amount of crystalloid infused are associated with prolonged time to extubation. However on multivariate modelling only FFP transfusion of more than 6 units was associated with prolonged extubation time

CLINICAL IMPLICATIONS: With identification of factors associated with early extubation in patient post liver transplant surgery, our hope is to ultimately develop risk predictor tool to determine which patients would be a candidate for rapid extubation.

DISCLOSURE: The following authors have nothing to disclose: Devang Sanghavi, Kumar Sarvottam, Rahul Kashyap, Bibek Pannu, Julie Heimbach, Vivek Iyer

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