Fullington Nora M, Cauley Ryan P, Potanos Kristina M, O'Melia Laura, Zurakowski David, Bae Kim Heung, Seefelder Christian, Vakili Khashayar
Departments of Surgery, Boston Children's Hospital, Boston, MA.
Liver Transpl. 2015 Jan;21(1):57-62. doi: 10.1002/lt.24036.
The care of pediatric liver transplant recipients has traditionally included postoperative mechanical ventilation. In 2005, we started extubating children undergoing liver transplantation in the operating room according to standard criteria for extubation used for general surgery cases. We reviewed our single-center experience to determine our rates of immediate extubation and practice since that time. The records of 84 children who underwent liver transplantation from 2005 to 2011 were retrospectively reviewed. The immediate extubation rate increased from 33% during 2005-2008 to 67% during 2009-2011. Immediate extubation did not result in an increased reintubation rate in comparison with delayed extubation in the intensive care unit (ICU). Patients undergoing immediate extubation had a trend toward a shorter mean ICU stay as well as a significantly decreased overall hospital length of stay. Our findings suggest that there is a learning curve for instituting immediate extubation in the operating room after liver transplantation and that the majority of pediatric liver recipients can safely undergo immediate extubation.
传统上，小儿肝移植受者的护理包括术后机械通气。2005年，我们开始根据普通外科病例的拔管标准，在手术室对接受肝移植的儿童进行拔管。我们回顾了我们的单中心经验，以确定自那时以来我们的即时拔管率和做法。对2005年至2011年期间接受肝移植的84名儿童的记录进行了回顾性审查。即时拔管率从2005 - 2008年期间的33%上升至2009 - 2011年期间的67%。与在重症监护病房（ICU）延迟拔管相比，即时拔管并未导致再插管率增加。接受即时拔管的患者平均ICU住院时间有缩短趋势，且总体住院时间显著缩短。我们的研究结果表明，肝移植后在手术室进行即时拔管存在一个学习曲线，并且大多数小儿肝移植受者可以安全地进行即时拔管。
