title: Noninvasive ventilation for pediatric patients including those under 1-year-old undergoing liver transplantation.
abstract: Pulmonary complications are an important cause of the mortality associated with liver transplantation. The efficacy of noninvasive ventilation (NIV) in pediatric patients following transplantation is unknown. The purpose of this retrospective study is to investigate the effects of NIV for pediatric patients undergoing liver transplantation. Of 102 pediatric patients who underwent liver transplantation, 15 patients (aged 73 months; range 2.5-179) were supported by NIV because of atelectasis, hypercapnia, hypoxemia, pneumonia, massive effusion, or postextubation ventilatory support. Of 15 patients, 5 were under the age of 1 year (range 2.5-12 months). Of the 15 patients, 7 had required multiple intubations before NIV treatment because of pulmonary complications. NIV treatment was administered to 6 patients because of hypercapnia. Partial pressure of arterial carbon dioxide (PaCO(2)) levels improved from 56.9 (95% confidence interval [CI]: 48.4-65.4) to 41.5 (95% CI: 36.8-46.2) mmHg (P = .028) within 2 days. NIV treatment was very effective for patients with atelectasis with and without other pulmonary complications. Mean inspiratory positive pressure (IPAP) was 7.2 (95% CI: 6.0-8.3) cm H(2)O and expiratory positive pressure (EPAP) was 3.5 (95% CI: 3.2-3.9) cm of H(2)O. Mean duration of NIV was 18.5 (95% CI: 8.6-28.4) days. IPAP and EPAP levels were closely and significantly correlated with height (IPAP: r = .65, P = .016; EPAP: r = .77, P = .004). A total of 13 patients recovered and 2 patients died. However, no patient died of respiratory complications. In conclusion, NIV is effective in pediatric patients undergoing liver transplantation with subsequent pulmonary complications. The IPAP and EPAP levels may be predicted by the height of the patient.
authors.affiliation: Department of Physical Therapeutics, Kyoto University Hospital, Kyoto 606-8507, Japan. chink@kuhp.kyoto-u.ac.jp
authors.forename: Kazuo
authors.initials: K
authors.lastname: Chin
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Takahashi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Kensuke
authors.initials: K
authors.lastname: Sumi
authors.forename: Michiaki
authors.initials: M
authors.lastname: Mishima
authors.forename: Colin E
authors.initials: CE
authors.lastname: Sullivan
authors.forename: Kouichi
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D006935:Hypercapnia / Q000628:therapy; D007223:Infant; D016031:Liver Transplantation; D008171:Lung Diseases / Q000209:etiology / Q000628:therapy*; D011014:Pneumonia / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D001261:Pulmonary Atelectasis / Q000628:therapy; D012121:Respiration, Artificial; D012189:Retrospective Studies