Abstract
BackgroundPostoperative 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.MethodsOf 511 adult patients who received living-donor LT, data on the 179 who were treated by NIV were retrospectively examined.ResultsForty-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).ConclusionsBecause 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.
Highlights
Liver transplantation (LT) has become the mainstay for the treatment of end-stage liver disease, acute liver failure, hepatocellular cancer, and some metabolic liver diseases [1]
Postoperative respiratory complications (PRCs) such as atelectasis, pleural effusion, pulmonary edema, and pneumonia are frequent after liver transplantation (LT) and their incidence is reported to be between
Fifteen patients had controlled preoperative infections; 5 pneumonia, 7 spontaneous bacterial peritonitis (SBP), and 1 either cholangitis, phlegmon, or enterocolitis. These preoperative infections had been controlled before the LT (Table 2)
Summary
Liver transplantation (LT) has become the mainstay for the treatment of end-stage liver disease, acute liver failure, hepatocellular cancer, and some metabolic liver diseases [1]. In immunosuppressed patients who failed NIV, the rate of hospital mortality was reported to be very high, ABO Incomptible APACHE II Postoperative data: Hb (g/dl) Total bilirubin (mg/dl) CRP (mg/dl) Na(mEq/l) HR (beats per minute) RR (beats per minute) Reintubation before NIV Extubation (days) From Extubation to NIV(days) Reasons for NIV: PaO2/FIO2 #250 PaCO2 $45 Torr Pneumonia on NIV Respiratory rate $25/min Atelectasis Massive pleural effusion Other reasons Settings of NIV: Mode (S/T/ST) IPAP (cmH2O) EPAP (cmH2O) Amount of oxygen (l/min). To calculate the FIO2 during NIV, we used the value from the information supplied by the manufacturer and was attached to the mask Using this information, the FIO2 was determined from the following parameters: leakage flow rate per minute from the mask at each pressure and the oxygen flow rate per minute during NIV. The predictors of reintubation following NIV therapy after LT are not exactly known
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