The clinical value of early extubation.
OBJECTIVE
The trend to extubate patients as soon as possible following large and complex surgery is supported by a large body of evidence showing early extubation is safe and saves money. However, the use of early extubation in liver transplant recipients is still debated. This review will explore the reasons why there is still resistance to the use of early extubation in liver transplantation.


RESULTS
Studies show the majority of liver transplant recipients can be extubated immediately after surgery. A multiinstitutional study addressed the safety of immediate postoperative intubation and confirmed that the rate of complications and reintubation was similar to the very low rate observed in recovery room patients. Investigators, however, cannot agree on what patient or donor factors predict successful extubation. These variables seem to differ between institutions.


CONCLUSIONS
There is robust evidence to support the use of immediate postoperative ventilation in liver transplant recipients. There is no evidence, however, to show that routine ventilation of all transplant recipients provides outcomes that are as good as those documented in extubated patients. It is probably time to turn the evidentiary tables around and ask proponents of routine ventilation to prove that they have done no harm and that they meet the new minimal performance standards established by immediate postoperative extubation.
Mandell
Mercedes S
MS
Department of Anesthesiology, University of Colorado Health Sciences Center, Academic Office One, 12631 E. 17th Avenue, Aurora, CO 80045, USA. Susan.Mandell@UCHSC.edu
Campsen
Jeffery
J
Zimmerman
Michael
M
Biancofiore
Gianni
G
Tsou
Mei-Yung
MY
D017046:Cost Savings; D019317:Evidence-Based Medicine; D049673:History, 20th Century; D049674:History, 21st Century; D017721:Hospital Costs; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000191:economics / Q000266:history; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics / Q000266:history; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000009:adverse effects / Q000191:economics / Q000266:history; D018570:Risk Assessment; D013997:Time Factors