title: Postoperative tracheal extubation after orthotopic liver transplantation.
abstract: BACKGROUND
  The duration of postoperative mechanical ventilation and its influence on pulmonary function in liver transplant recipients is still debated controversially.
  
  
  METHODS
  We retrospectively analyzed the incidence of immediate tracheal extubation, prolonged mechanical ventilation (>24 h following surgery), and episodes of reintubation in 546 patients who underwent orthotopic liver transplantation (OLT) at our institution.
  
  
  RESULTS
  Immediate tracheal extubation in the operating theater was achieved in 18.7% of patients, and prolonged mechanical ventilation was required by 11.2% of patients. In these, median time of extubation was 49.5 h, whereas the remaining 70.1% of patients required ventilation support for a median 5 h after OLT. As risk factors for prolonged mechanical ventilation we identified the indications of acute liver failure and retransplantation, as well as factors such as mechanical ventilation prior to OLT, massive intraoperative bleeding, and severe reperfusion injury of the liver graft. The incidence of reintubation was 8.8% in patients who were immediately extubated following surgery, and 13.1% in patients who underwent extubation within 24 h. The incidence was significantly increased in patients requiring prolonged mechanical ventilation (36.1%).
  
  
  CONCLUSIONS
  Immediate tracheal extubation was safe and well tolerated. The incidence of reintubation was not increased when compared to patients in whom extubation succeeded later. However, special attention should be given to transplant recipients presenting in reduced clinical condition at the time of OLT, undergoing complicated surgery, or receiving liver allografts with severe reperfusion injury because of an increased risk for prolonged mechanical ventilation.
authors.affiliation: Department of General, Visceral & Transplantation Surgery, Charité, Humboldt University Berlin, Germany. matthias.glanemann@charite.de
authors.forename: M
authors.initials: M
authors.lastname: Glanemann
authors.forename: J
authors.initials: J
authors.lastname: Langrehr
authors.forename: U
authors.initials: U
authors.lastname: Kaisers
authors.forename: R
authors.initials: R
authors.lastname: Schenk
authors.forename: A
authors.initials: A
authors.lastname: Müller
authors.forename: B
authors.initials: B
authors.lastname: Stange
authors.forename: U
authors.initials: U
authors.lastname: Neumann
authors.forename: W O
authors.initials: WO
authors.lastname: Bechstein
authors.forename: K
authors.initials: K
authors.lastname: Falke
authors.forename: P
authors.initials: P
authors.lastname: Neuhaus
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015427:Reperfusion Injury / Q000150:complications; D012121:Respiration, Artificial; D015996:Survival Rate; D013997:Time Factors