O'Meara Moira E, Whiteley Simon M, Sellors Jane M, Luntley Jeremy M, Davison Suzanne, McClean Patricia, Rajwal Sanjay, Prasad Raj, Stringer Mark D
Department of Anesthesia, St. James's University Hospital, Leeds, United Kingdom.
Transplantation. 2005 Oct 15;80(7):959-63. doi: 10.1097/01.tp.0000174132.18652.81.
Immediate tracheal extubation of selected adult patients after orthotopic liver transplant (OLT) is common practice. We hypothesized that selected children may be safely extubated immediately after OLT and avoid potentially deleterious effects of artificial ventilation and sedation.
After June 2002, we chose immediate extubation unless a specific contraindication was identified. Charts of all children undergoing OLT between June 2002 and February 2005 were reviewed to audit safety and outcome of this approach. Comparative data were obtained for children undergoing first elective OLT at other UK centers.
Forty-six cadaveric liver transplants were performed in 40 patients: 26 of 34 (76%) elective transplants and 4 of 12 (33%) urgent transplants were extubated immediately after surgery. Eight of 14 (57%) children weighing less than 10 kg were successfully extubated. One child required reintubation after developing transfusion-related acute lung injury. There were no other events compromising patient or graft. Small recipient size, split/reduced grafts, preexisting respiratory disease, retransplantation, and acute liver failure did not individually preclude successful immediate extubation. After elective OLT, the mean duration of intensive care stay was significantly shorter in the extubated group than in those who were ventilated (2.5 vs. 6.1 days, P<0.01). All children receiving a liver transplant at other UK centers in 2003 were ventilated postoperatively. However, the median duration of intensive care stay (2 days) was the same as in our series.
Immediate extubation of selected children after OLT is safe. It may enhance patient recovery, benefit graft physiology, and reduce intensive care requirement.
对部分成年原位肝移植（OLT）患者立即进行气管拔管是常见做法。我们推测部分儿童患者在OLT术后可安全地立即拔管，避免人工通气和镇静带来的潜在有害影响。
2002年6月以后，除非有明确的禁忌证，我们均选择立即拔管。回顾了2002年6月至2005年2月期间所有接受OLT的儿童患者病历，以评估该方法的安全性和结果。获取了英国其他中心接受首次择期OLT儿童患者的对比数据。
40例患者接受了46例尸体肝移植：34例择期移植中的26例（76%）和12例急诊移植中的4例（33%）在术后立即拔管。14例体重小于10kg的儿童中有8例（57%）成功拔管。1例儿童在发生输血相关急性肺损伤后需要重新插管。没有其他影响患者或移植物的事件发生。受体体型小、劈离/缩小移植物、既往存在的呼吸系统疾病、再次移植和急性肝衰竭均未单独排除成功立即拔管的可能。择期OLT后，拔管组的重症监护平均住院时间显著短于通气组（2.5天对6.1天，P<0.01）。2003年在英国其他中心接受肝移植的所有儿童术后均进行了通气。然而，重症监护的中位住院时间（2天）与我们系列中的相同。
OLT术后对部分儿童立即拔管是安全的。这可能会促进患者康复，有利于移植物生理功能，并减少对重症监护的需求。
