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Extubation score in the operating room after liver transplantation
Author(s) -
SKURZAK S.,
STRATTA C.,
SCHELLINO M. M.,
FOP F.,
ANDRUETTO P.,
GALLO M.,
RAMPA P.,
CRUCITTI M.,
ZABATTA D.,
PANIO A.,
CERUTTI E.
Publication year - 2010
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2010.02274.x
Subject(s) - medicine , liver transplantation , logistic regression , transplantation , univariate analysis , surgery , anesthesia , weaning , multivariate analysis
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 μg/kg/min or norepinephrine higher than 0.05 μg/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. Conclusion: 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.