Sahinturk Helin, Ozdemirkan Aycan, Zeyneloglu Pinar, Torgay Adnan, Pirat Arash, Haberal Mehmet
From the Anesthesiology and ICM Department, Baskent University Faculty of Medicine, Ankara, Turkey.
Exp Clin Transplant. 2021 Sep;19(9):943-947. doi: 10.6002/ect.2018.0317. Epub 2019 May 14.
Duration of postoperative mechanical ventilation after pediatric liver transplant may influence pulmonary functions, and postoperative prolonged mechanical ventilation is associated with higher morbidity and mortality. Here, we determined its incidence and risk factors after pediatric liver transplant at our center.
We retrospectively analyzed the records of 121 children who underwent liver transplant between April 2007 and April 2017 (305 total liver transplant procedures were performed during this period). Prolonged mechanical ventilation was defined as postoperative tracheal extubation after 24 hours.
Mean age at transplant was 6.2 ± 5.4 years and 71/121 children (58.7%) were male. Immediate tracheal extubation was achieved in 68 children (56.2%). Postoperative prolonged mechanical ventilation was needed in 12 children (9.9%), with mean extubation time of 78.0 ± 83.4 hours. Reintubation was required in 13.4%. Logistic regression analysis revealed that presence of preoperative hepatic encephalopathy (odds ratio of 0.130; 95% confidence interval, 0.027-0.615; P = .01), high aspartate amino transferase levels (odds ratio of 1.001; 95% confidence interval, 1.000-1.002; P = .02), intraoperative usage of more packed red blood cells (odds ratio of 1.001; 95% confidence interval, 1.000-1.002; P = .04), and longer surgery duration (odds ratio of 0.723; 95% confidence interval, 0.555-0.940, P = .01) were independent risk factors for postoperative prolonged mechanical venti-lation. Although mean length of intensive care unit stay was significantly longer (12.6 ± 13.6 vs 6.0 ± 0.6 days; P = .001), mortality was similar in children with and without postoperative prolonged mechanical ventilation.
Our results indicate that postoperative prolonged mechanical ventilation was needed in 9.9% of our children. Predictors of postoperative prolonged mechanical ventilation after pediatric liver transplant at our center were preoperative presence of hepatic encephalopathy, high aspartate amino transferase levels, intraoperative usage of more packed red blood cells, and longer surgery duration.
小儿肝移植术后机械通气时间可能会影响肺功能，术后长时间机械通气与较高的发病率和死亡率相关。在此，我们确定了我院小儿肝移植术后长时间机械通气的发生率及其危险因素。
我们回顾性分析了2007年4月至2017年4月期间接受肝移植的121例儿童的记录（在此期间共进行了305例全肝移植手术）。长时间机械通气定义为术后24小时后气管拔管。
移植时的平均年龄为6.2±5.4岁，71/121例儿童（58.7%）为男性。68例儿童（56.2%）实现了即刻气管拔管。12例儿童（9.9%）术后需要长时间机械通气，平均拔管时间为78.0±83.4小时。再次插管率为13.4%。Logistic回归分析显示，术前存在肝性脑病（比值比为0.130；95%置信区间为0.027 - 0.615；P = 0.01）、高天冬氨酸转氨酶水平（比值比为1.001；95%置信区间为1.000 - 1.002；P = 0.02）、术中使用更多的浓缩红细胞（比值比为1.001；95%置信区间为1.000 - 1.002；P = 0.04）以及手术时间较长（比值比为0.723；95%置信区间为{0.555 - 0.940}，P = 0.01）是术后长时间机械通气的独立危险因素。尽管重症监护病房的平均住院时间显著更长（12.6±13.6天 vs 6.0±0.6天；P = 0.001），但术后有或没有长时间机械通气的儿童死亡率相似。
我们的结果表明，9.9%的儿童术后需要长时间机械通气。我院小儿肝移植术后长时间机械通气的预测因素为术前存在肝性脑病、高天冬氨酸转氨酶水平、术中使用更多的浓缩红细胞以及手术时间较长。
