Immediate extubation of children following liver transplantation is safe and may be beneficial.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Immediate extubation of selected children after OLT is safe. It may enhance patient recovery, benefit graft physiology, and reduce intensive care requirement.
O'Meara
Moira E
ME
Department of Anesthesia, St. James's University Hospital, Leeds, United Kingdom. cck@ntlworld.com
Whiteley
Simon M
SM
Sellors
Jane M
JM
Luntley
Jeremy M
JM
Davison
Suzanne
S
McClean
Patricia
P
Rajwal
Sanjay
S
Prasad
Raj
R
Stringer
Mark D
MD
D002648:Child; D006801:Humans; D007442:Intubation, Intratracheal; D016031:Liver Transplantation; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*