title: Predictive factors for reintubation following noninvasive ventilation in patients with respiratory complications after living donor liver transplantation.
abstract: BACKGROUND
  Postoperative respiratory complications are a major cause of mortality following liver transplantation (LT). Noninvasive ventilation (NIV) appears to be effective for respiratory complications in patients undergoing solid organ transplantation; however, mortality has been high in patients who experienced reintubation in spite of NIV therapy. The predictors of reintubation following NIV therapy after LT are not exactly known.
  
  
  METHODS
  Of 511 adult patients who received living-donor LT, data on the 179 who were treated by NIV were retrospectively examined.
  
  
  RESULTS
  Forty-three (24%) of the 179 patients who received NIV treatment required reintubation. Independent factors associated with reintubation by multivariate logistic regression analysis were controlled preoperative infections (odds ratio [OR] 8.88; 95% confidence interval (CI) 1.64 to 48.11; p = 0.01), ABO-incompatibility (OR 4.49; 95% CI, 1.50 to 13.38; p = 0.007), and presence of postoperative pneumonia at the time of starting NIV (OR 3.28; 95% CI, 1.02 to 11.01; p = 0.04). The reintubated patients had a significant higher rate of postoperative infectious complications and a significantly longer intensive care unit stay than those in whom NIV was successful (p<0.0001). Of the 43 reintubated patients, 22 (51.2%) died during hospitalization following LT vs. 8 (5.9%) of the 136 patients in whom NIV was successful (p<0.0001).
  
  
  CONCLUSIONS
  Because controlled preoperative infection, ABO-incompatibility or pneumonia prior to the start of NIV were independent risk factors for reintubation following NIV, caution should be used in applying NIV in patients with these conditions considering the high rate of mortality in patients requiring reintubation following NIV.
authors: Department of Respiratory Medicine, Kyoto University Hospital, Kyoto, Japan.
authors: Yuichi
authors: Y
authors: Chihara
authors: Hiroto
authors: H
authors: Egawa
authors: Toru
authors: T
authors: Oga
authors: Tomomasa
authors: T
authors: Tsuboi
authors: Tomohiro
authors: T
authors: Handa
authors: Shintaro
authors: S
authors: Yagi
authors: Taku
authors: T
authors: Iida
authors: Atsushi
authors: A
authors: Yoshizawa
authors: Kazuhiko
authors: K
authors: Yamamoto
authors: Michiaki
authors: M
authors: Mishima
authors: Koichi
authors: K
authors: Tanaka
authors: Shinji
authors: S
authors: Uemoto
authors: Kazuo
authors: K
authors: Chin
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007440:Intubation; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D011184:Postoperative Period; D057234:Preoperative Period; D011379:Prognosis; D012140:Respiratory Tract Diseases / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies