Abstract
1Braz J Tranpl■v25 n1■e0222■2022Abstract: The aim of this observational study was to evaluate the risk factors and predictive indexes of reintubation in patients after liver transplantation in the intensive care unit of a university hospital. The time at the intensive care unit, time on mechanical ventilation, use of noninvasive ventilation, ventilator-associated pneumonia, mortality, sequential organ failure assessment scores (SOFA), simplified acute physiology score (SAPS 3), model for end-stage liver disease (MELD), Child-Pugh (CHILD), Acute Physiology and Chronic Health Disease Classification System II (APACHE II), and balance of risk score (BAR) were correlated with reintubation. The following tests were used for the statistical analysis: Kolmogorov-Smirnov, χ2, Student’s t-test, and regression analysis and receiver operating characteristic (ROC) curve. Two hundred and thirty-seven individuals were analyzed. Among them, 38 (16%) were reintubated. The comparative analysis was performed between reintubated and non-reintubated individuals. The variables analyzed – ventilator associated pneumonia, death, mechanical ventilation time, intensive care unit time, noninvasive ventilation use, MELD score, SAPS 3, BAR, and SOFA third days – after liver transplantation were significantly different (p < 0.001). In the multivariate regression analysis, the predictors of reintubation after liver transplantation were ventilator associated pneumonia (odds ratio – OR = 10.6; 95% confidence interval – 95%CI 1.04-108.3; p = 0.04) and BAR (OR = 1.18; 95%CI 1.02-1.36; p = 0.02). The highest ROC curves were SOFA third day, MELD, SAPS 3 and BAR scores through the intersections of the sensitivity and specificity curves > 0.70. High values of the BAR score were considered risk factors for reintubation in this study. SOFA third day showed moderate discriminatory power in predicting reintubation after liver transplantation.
Highlights
Mechanical ventilation is a life-saving intervention, but the timing of liberation from invasive mechanical ventilation is an important issue for clinicians caring for critically ill intubated patients receiving mechanical ventilation in intensive care units (ICUs).[1]
The death rate, prevalence of ventilator assisted pneumonia (VAP), time of mechanical ventilation, use of noninvasive ventilation, length of hospital stay ICU, hospitalization, value of the SOFA in the third day, SAPS 3, and balance of risk score (BAR) showed statistically significant higher values p < 0.05 in the reintubation group compared with non-reintubation group
It has been observed that the area under the curve (AUC) the receiver operating characteristic (ROC) for SOFA score third days was 0.7 (95%confidence intervals (CIs) 0.59-0.82; p = 0.001), SAPS 3 0.64 (95%CI 0.52-0.77; p = 0.02), BAR 0.65 (95%CI 0.2-0.77; p = 0.01) and model for end-stage liver disease (MELD) 0.62 (95%CI 0.48-0.76; p = 0.04) in Fig. 1 showed moderate discriminatory power in predicting reintubation after liver transplantation
Summary
Mechanical ventilation is a life-saving intervention, but the timing of liberation from invasive mechanical ventilation is an important issue for clinicians caring for critically ill intubated patients receiving mechanical ventilation in intensive care units (ICUs).[1]. Risk Factors for Reintubation Related to Non-Airway Failure After Liver Transplantation in Intensive Care Unit: Observational Study basis. Extubation failure happens due to airway failure caused by upper-airway obstruction and lower-airway obstruction due to aspiration or excessive respiratory secretions. Airway obstruction is related with witnessed aspiration or inability to maintain airway patency because of respiratory secretions, ineffective cough or inability to expectorate. It is necessary repeated nasotracheal aspiration development of atelectasis during the post-extubation period.[4] Extubation failure due to non-airway failure was defined by Epstein and Ciubotaru,[5] and congestive heart failure, respiratory failure due to lung disease and hypoventilation were included in this category
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