title: Extubation score in the operating room after liver transplantation.
abstract: BACKGROUND
  Early extubation after liver transplantation (LT) is an increasingly applied safe practice. The aim of the present study was to provide a simple extubation rule for accelerated weaning in the operating room (OR).
  
  
  METHODS
  Data of 597 patients transplanted at the LT center of Turin (Italy) were retrospectively analyzed. Fifty-two nonextubated patients (excluding those with a scheduled early reoperation) were compared with 545 successfully extubated patients (not in need of reintubation within the first 48 h). Significant variables at univariate analysis were entered into a logistic regression model and the regression coefficients of independent predictors were used to yield a prognostic score called the safe operating room extubation after liver transplantation (SORELT) score.
  
  
  RESULTS
  Two major and three minor criteria were found. The major ones were blood transfusions (higher than/or equal to 7 U of packed red blood cells) and end of surgery lactate (higher than/or equal to 3.4 mmol/l). The minor ones were status before LT (home vs. hospitalized patient), duration of surgery (longer than/or equal to 5 h), vasoactive drugs at the end of surgery (dopamine higher than 5 microg/kg/min or norepinephrine higher than 0.05 microg/kg/min). Patients who fulfill the SORELT score-derived criteria (fewer than two major/one major plus two minor/three minor criteria) can be considered for OR extubation.
  
  
  CONCLUSIONS
  Early extubation after LT requires a very careful assessment of the pre-operative, intraoperative, graft and post-operative care data available. The SORELT score helps as a simple and objective aid in considering such a decision.
authors.affiliation: Dipartimento di Anestesia e Medicina degli stati critici, Ospedale San Giovanni Battista, Corso Bramante 88, Torino, Italy. sskurzak@yahoo.it
authors.forename: S
authors.initials: S
authors.lastname: Skurzak
authors.forename: C
authors.initials: C
authors.lastname: Stratta
authors.forename: M M
authors.initials: MM
authors.lastname: Schellino
authors.forename: F
authors.initials: F
authors.lastname: Fop
authors.forename: P
authors.initials: P
authors.lastname: Andruetto
authors.forename: M
authors.initials: M
authors.lastname: Gallo
authors.forename: P
authors.initials: P
authors.lastname: Rampa
authors.forename: M
authors.initials: M
authors.lastname: Crucitti
authors.forename: D
authors.initials: D
authors.lastname: Zabatta
authors.forename: A
authors.initials: A
authors.lastname: Panio
authors.forename: E
authors.initials: E
authors.lastname: Cerutti
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D019540:Area Under Curve; D001803:Blood Transfusion; D002407:Catheterization, Swan-Ganz; D020878:Device Removal; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007442:Intubation, Intratracheal; D019344:Lactic Acid / Q000097:blood; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012449:Safety; D055815:Young Adult
chemical_list: D019344:Lactic Acid