title: A multicenter evaluation of safety of early extubation in liver transplant recipients.
abstract: Small single-institutional studies performed prior to the introduction of organ allocation using the Model for End-Stage Liver Disease (MELD) suggest that early airway extubation of liver transplant recipients is a safe practice. We designed a multicenter study to examine adverse events associated with early extubation in patients selected for liver transplantation using MELD score. A total of 7 institutions extubated all patients meeting study criteria and reported adverse events that occurred within 72 hours following surgery. Adverse events were uncommon: occurring in only 7.7% of 391 patients studied. Most adverse events were pulmonary or surgically related. Pulmonary complications were usually minor, requiring only an increase in ambient oxygen concentration. The majority of surgical adverse events required additional surgery. Analysis of a limited set of perioperative variables suggest that blood transfusions and technical factors were associated with an increased risk of adverse events. In conclusion, while early extubation appears to be safe under specified circumstances, there are performance differences between institutions that remain to be explained.
authors.affiliation: Department of Anesthesiology, University of Colorado Health Sciences Center, Denver, CO 80262, USA. susan.mandell@uchsc.edu
authors.forename: M Susan
authors.initials: MS
authors.lastname: Mandell
authors.forename: Tamara J
authors.initials: TJ
authors.lastname: Stoner
authors.forename: Rebecca
authors.initials: R
authors.lastname: Barnett
authors.forename: Abraham
authors.initials: A
authors.lastname: Shaked
authors.forename: Mark
authors.initials: M
authors.lastname: Bellamy
authors.forename: Gianni
authors.initials: G
authors.lastname: Biancofiore
authors.forename: Claus
authors.initials: C
authors.lastname: Niemann
authors.forename: Ann
authors.initials: A
authors.lastname: Walia
authors.forename: Youri
authors.initials: Y
authors.lastname: Vater
authors.forename: Zung V
authors.initials: ZV
authors.lastname: Tran
authors.forename: Igal
authors.initials: I
authors.lastname: Kam
mesh_terms: D020878:Device Removal; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D012121:Respiration, Artificial; D013997:Time Factors