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Early postoperative intensive care in cadaveric liver transplantation: factors affecting the length of intensive care unit stay

Liver transplantation (LT) patients have problems involving different organ systems which have a critical role in the success of the procedure. The purpose of this study is to evaluate the factors contributing to the duration of mechanical ventilation (MV) and the length of stay in ICU after LT.

Materials and methods

We evaluated 53 cadaveric liver transplantation operated by using simple cross clamping technique without venovenous bypass. All the patients were transferred to the multidisciplinary ICU for early postoperative care where all vital organ systems were monitored. Twenty-one different factors were evaluated by Mann–Whitney U, Student's t-tests and by regression analysis. All values are as mean ± SD.

Results

The mean age of the patients was 36.6 ± 15.4 years (F:M 18/35). Preoperative mean Child–Pugh scores of the patients was 10.9 ± 2.3, the perioperative course had a mean operation time of 342 ± 113 min and a mean anhepatic period of 80 ± 36 min. Mean duration of MV and length of stay in ICU were 22 ± 22 hours and 50 ± 39 hours respectively. Factors on Table 1 prolonged the duration of MV and the length of ICU stay. The analysis of regression showed no correlation between duration of MV and/or the length of ICU stay with age, Child–Pugh scores, duration of operations and anhepatic periods, total protein, glucose and bilirubine levels, prothrombin times and the need for transfusion except for the SGOT (r2 = 0.18, P < 0.001) and SGPT (r2 = 0.22, P < 0.001) levels which caused longer durations of MV.

Table 1 Factors that affect the durations of MV and the length of ICU stay (hours, mean ± SD)

Conclusion

During early postoperative course of the OLT patients, clinical factors such as presence of a hypoxemic and/or hypercapnic period, difficulties in weaning from MV, hemodynamic instability, increase in plasma urea and/or creatinine levels, decrease in plasma calcium levels, and postoperative fever might be indicative for a prolonged ICU stay and a possible increase in morbidity.

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Ulukaya, S., Ayanoglu, H., Olgun, E. et al. Early postoperative intensive care in cadaveric liver transplantation: factors affecting the length of intensive care unit stay. Crit Care 5, P252 (2001). https://doi.org/10.1186/cc1317

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Keywords

  • Mechanical Ventilation
  • Liver Transplantation
  • Intensive Care Unit Stay
  • Hemodynamic Instability
  • Plasma Calcium