Analysis of the causal factors of prolonged mechanical ventilation after orthotopic liver transplant.
BACKGROUND
Prolonged mechanical ventilation and the consequently long stay in the intensive care unit (ICU) appear to be important infection risk factors in patients undergoing liver transplant.


METHODS
We analyzed the data relating to 70 liver transplants performed on 67 patients during the past year's activities. For each patient we have considered the presence of preoperative pulmonary alterations, the first radiological result of the postoperative thorax, the PaO(2)/FiO(2) ratio recorded in the peroperative phase immediately after induction of general anesthesia (T0), and arrival at the ICU at the end of the operation (T1). We also considered the enzyme trend (glutamate-oxalacetic transaminase [GOT] and glutamate-pyruvate transaminase [GPT]) recorded every 6 hours for the first 42 hours of the postoperative period (times T1 to T7).


RESULTS
There was an evident correspondence between the values of PaO(2)/FiO(2) < or = 300 ratio at time T1 and the subsequent duration of mechanical ventilation (P = .001). There was also a correlation between the PaO(2)/FiO(2) < or = 300 ratio at time T1 and the trend of the GPT in the first 24 hours postsurgery (P = .021; P = .026; P = .018; P = .048) or GOT trend over the same span of time (P = .027; P = .035; P = .048).


CONCLUSIONS
Graft malfunction as expressed by the enzyme trend affects both the duration of mechanical ventilation and the postoperative PaO(2)/FiO(2) ratios. This metric may be useful to reinforce infection surveillance and to perform an early percutaneous tracheostomy in these patients.
Faenza
S
S
Department of Surgery, Intensive Care and Transplantation, University of Bologna, Italy. aneria@med.unibo.it
Ravaglia
M S
MS
Cimatti
M
M
Dante
A
A
Spedicato
S
S
Labate
A M Morselli
AM
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016031:Liver Transplantation / Q000009:adverse effects*; D008171:Lung Diseases / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000628:therapy*; D011654:Pulmonary Edema / Q000209:etiology / Q000628:therapy; D013902:Radiography, Thoracic; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D016896:Treatment Outcome
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D010100:Oxygen