The clinical value of early extubation

Current Opinion in Organ Transplantation

Volumn 14, Issue 3, 2009, Pages 297-302

  Mandell, Mercedes S ^a   Campsen, Jeffery ^a   Zimmerman, Michael ^a   Biancofiore, Gianni ^b   Tsou, Mei Yung ^c  

^a UNIVERSITY OF COLORADO   (United States)

^b UNIVERSITY HOSPITAL OF PISA   (Italy)

^c TAIPEI VETERANS GENERAL HOSPITAL   (Taiwan)

Author keywords

Adverse events; Liver transplant; Resource utilization; Safety; Ventilation

Indexed keywords

ARTIFICIAL VENTILATION; BLOOD TRANSFUSION; COST CONTROL; COST EFFECTIVENESS ANALYSIS; EXTUBATION; GRAFT RECIPIENT; HEART SURGERY; HUMAN; IMMEDIATE POSTOPERATIVE EXTUBATION; INTENSIVE CARE UNIT; LIVER TRANSPLANTATION; MEDICAL DECISION MAKING; ORGAN DONOR; PATIENT CARE; POSTOPERATIVE CARE; POSTOPERATIVE PERIOD; RESPIRATORY FAILURE; RESPIRATORY TRACT INTUBATION; REVIEW; RISK ASSESSMENT; RISK FACTOR; SAFETY; TREATMENT OUTCOME; VASCULAR SURGERY; ECONOMICS; ENDOTRACHEAL INTUBATION; EVIDENCE BASED MEDICINE; HISTORY; HOSPITAL COST; PRACTICE GUIDELINE; TIME;

COST SAVINGS; EVIDENCE-BASED MEDICINE; HISTORY, 20TH CENTURY; HISTORY, 21ST CENTURY; HOSPITAL COSTS; HUMANS; INTUBATION, INTRATRACHEAL; LIVER TRANSPLANTATION; POSTOPERATIVE CARE; PRACTICE GUIDELINES AS TOPIC; RESPIRATION, ARTIFICIAL; RISK ASSESSMENT; TIME FACTORS;

EID: 67651028350     PISSN: 10872418     EISSN: 15317013     Source Type: Journal    
DOI: 10.1097/MOT.0b013e32832b2f6c     Document Type: Review

References (43)

1. Hawkes CA, Dhileepan S, Foxcroft D. Early extubation for adult cardiac surgical patients. Cochrane Database Syst Rev 2003:CD003587.
2. Biancofiore G, Romanelli AM, Bindi ML, et al. Very early tracheal extubation without predetermined criteria in a liver transplant recipient population. Liver Transpl 2001; 7:777-782. (Pubitemid 32851298)
3. Flynn M, Reddy S, Shepherd W, et al. Fast-tracking revisited: routine cardiac surgical patients need minimal intensive care. Euro J Cardiothorac Surg 2004; 25:116-122. (Pubitemid 38019068)
4. Reis J, Mota JC, Ponce P, et al. Early extubation does not increase complication rates after coronary artery bypass graft surgery with cardiopulmonary bypass. Euro J Cardiothorac Surg 2002; 21:1026-1030.
5. Ricci M. Fast track: are surgeons pushing the envelope too far in cardiac surgery? Eur J Cardiothorac Surg 2008; 33:953-954. This commentary shows the implicit concerns that physicians have about using early extubation.
6. Steadman RH. Con: immediate extubation for liver transplant. J Cardiothorac Vasc Anesth 2007; 21:756-757. This commentary outlines the main criticisms of IPE in liver transplant recipients.
7. Findlay JY, Janowski CJ, Vasdev GM, et al. Fast track anesthesia for liver transplantation reduces postoperative ventilation time but not intensive care unit stay. Liver Transpl 2002; 8:670-675.
8. Carton EG, Plevak DJ, Kranner PW, et al. Perioperative care of the liver transplant patient: part 2. Anesth Analg 1994; 78:382-399. (Pubitemid 24055861)
9. Hemmerling TM, Coiniere JL, Basile F, et al. Immediate extubation after aortic valve surgery using high thoracic epidural anesthesia. Heart Surg Forum 2004; 7:16-20. (Pubitemid 38263294)
10. Lin TY, Ciu KM, Lu CW, et al. Immediate extubation in the operating room after cardiac operations with thoracotomy and sternotomy. Acta Anesthesiol Taiwan 2007; 45:3-8. (Pubitemid 46505561)
11. Cohen J, Loewinger J, Hutin K, et al. The safety of immediate extubation after abdominal aortic surgery: a prospective, randomized trial. Anesth Analg 2001; 93:1546-1549. (Pubitemid 33111685)
12. Lanuti M, de Delva PE, Maher A, et al. Feasibility and outcomes of an early extubation policy after esophagectomy. Ann Thorac Surg 2006; 82:2037-2041. (Pubitemid 44778635)
13. Cammu G, Decruyenaere J, Troisi R, et al. Criteria for immediate postoperative extubation in adult recipients following living-related liver transplantation with total intravenous anesthesia. J Clin Anesth 2003; 15:515-519. (Pubitemid 38102162)
14. Biancofiore G, Bindi ML, Romanelli, et al. Fast track in liver transplantation: 5 years' experience. Eur J Anaesthesiol 2005; 22:584-590. (Pubitemid 41097860)
15. Glanemann M, Hoffmeister R, Neumann U, et al. Fast tracking in liver transplantation: which patient benefits from this approach? Transplant Proc 2007; 39:535-536. This study identifies variables that predict successful IPE at this institution.
16. Mandell M, Lezotte D, Kam I, Zamudio S. Reduced use of intensive care after liver transplantation: influence of early extubation: patient attributes that determine early transfer to the surgical wards. Liver Transpl 2002; 8:682-687. (Pubitemid 34884967)
17. Walia A, Schumann R. The evolution of liver transplantation practices. Curr Opin Organ Transplant 2008; 13:275-279. An excellent overall review about how transplantation including anesthesia practices have changed over time. The study explores how transplant surgery, medicine and anesthesia have interacted to improve overall outcome.
18. Ratnaraj J, Roy C, Kumar N, et al. Fast-tracking in patients undergoing coronary artery surgery with severely impaired left ventricular function. Ann Card Anaesth 1999; 2:12-15.
19. Mittnacht AJ, Thanjan M, Srivastava S, et al. Extubation in the operating room after congenital heart surgery in children. J Thorac Cardiovasc Surg 2008; 136:88-93.
20. Augoustides JG, Watcha SM, Pochettino A, Jobes DR. Early tracheal extubation in adults undergoing single-lung transplantation for chronic obstructive pulmonary disease: pilot evaluation of perioperative outcome. Interact Cardiovasc Thorac Surg 2008; 7:755-758. This study describes IPE in lung transplant patient.
21. O'Meara ME, Whiteley SM, Sellors JM, et al. Immediate extubation of children following liver transplantation is safe and may be beneficial. Transplantation 2005; 80:959-963.
22. Food and Drug Administration HHS. Current good manufacturing practice and investigational new drugs intended for use in clinical trials. Final rule. Fed Regist 2008; 73:40453-40463.
23. Araz C, Pirat A, Torgay A, et al. Early postoperative complications of pediatric liver transplantation: experience at one center. Transplant Proc 2004; 36:214-217. (Pubitemid 38177237)
24. Ulukaya S, Arikan C, Aydogdu S, et al. Immediate tracheal extubation of pediatric liver transplant recipients in the operating room. Pediatr Transplant 2003; 7:381-384. (Pubitemid 37295945)
25. Mandell MS, Stoner TJ, Barnett R, et al. A multicenter evaluation of safety of early extubation in liver transplant recipients. Liver Transpl 2007; 13:1557-1563. This is a study of IPE outcomes at seven centers, five in the United States and two in Europe. The investigators find that the rate of complications is small and most are minor. They also find that there are significant performance differences between institutions, as two centers accounted for most of the complications recorded in the study. (Pubitemid 350168197)
26. Snowden CP, Hughes T, Rose J, Roberts DR. Pulmonary edema in patients after liver transplantation. Liver Transpl 2000; 6:466-470. (Pubitemid 30489121)
27. Kluger MT, Bullock MF. Recovery room incidents: a review of 419 reports from the Anaesthetic Incident Monitoring Study (AIMS). Anaesthesia 2002; 57:1060-1066.
28. Elgringham RJ. Complications in the recovery room. J R Soc Med 1979; 72:278-280.
29. Lee PJ, MacLennan A, Naughton NN, O'Reilly M. An analysis of reintubations from a quality assurance database of 152 000 cases. J Clin Anesth 2003; 15:575-581. (Pubitemid 38064277)
30. Mandell MS, Lockrem J, Kelley SD. Immediate tracheal extubation after liver transplantation: experience of two transplant centers. Anesth Analg 1997; 84:249-253. (Pubitemid 27061385)
31. Slim K, Nini E, Forestier D, et al. Methodological index for nonrandomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 2003; 73:712-716. (Pubitemid 37267119)
32. Neelakanta G, Sopher M, Chan S, et al. Early tracheal extubation after liver transplantation. J Cardiothorac Vasc Anesth 1997; 11:165-167. (Pubitemid 27175439)
33. Zeyneloglu P, Pirat A, Guner M, et al. Predictors of immediate tracheal extubation in the operating room after liver transplantation. Transplant Proc 2007; 39:1187-1189. The authors examined the variables that affect IPE. They analyzed differences in traits between IPE patients and those who needed prolonged ventilation. Logistic regression shows that only emergent surgery and intraoperative hypotension were significantly associated with a lower probability of successful IPE. (Pubitemid 46764820)
34. Altman DG. What randomized trials and systematic trials can offer decision makers? Hormone Res 1999; 51 (supp):36-43.
35. Transplant recipient characteristics, deceased donor transplants, Scientific Registry of Transplant Recipients. http://www.ustransplant.org/csr/ current/nationalViewer.aspx [Accessed 25 March, 2009].
36. Walia A, Stoner T, Michaels D, et al. LTrAC 101 - looking for evidence. American Society of Anesthesiologists Annual Meeting; October 2008; Orlando, Florida.
37. Rana A, Hardy MA, Halazun KJ, et al. Survival Outcomes Following Liver Transplantation (SOFT) Score: a novel method to predict patient survival following liver transplantation. Am J Transplant 2008; 8:2537-2546. The investigators describe a method for predicting survival at 3 months following transplantation. They identify 13 recipients, four donor and two intraoperative factors that affect outcome. This article shows the complex series of variables that affect overall outcome that probably also have an effect upon IPE outcome.
38. Mandell MS, Lezotte D, Kam I, Zamudio S. Reduced use of intensive care after liver transplantation: influence of early extubation. Liver Transpl 2002; 8:676-681. (Pubitemid 34884966)
39. Cheng DC, Karski J, Peniston C, et al. Early tracheal extubation after coronary artery bypass graft surgery reduces costs and improves resource use. A prospective, randomized, controlled trial. Anesthesiology 1996; 85:1300-1310.
40. Calafiore AM, Scipioni G, Teodori G, et al. Day 0 intensive care unit discharge - risk or benefit for the patient who undergoes myocardial revascularization? Eur J Cardiothorac Surg 2002; 21:377-384.
41. Showstack J, Katz PP, Lake JR, et al. Resource utilization in liver transplantation: effects of patient characteristics and clinical practice. NIDDK Liver Transplantation Database Group. JAMA 1999; 281:381-386.
42. Papadimos TJ, Hensley SJ, Duggan JM, et al. Implementation of the 'FASTHUG' concept decreases the incidence of ventilator-associated pneumonia in a surgical intensive care unit. Patient Saf Surg 2008; 2:3.
43. El-Khatib MF, Bou-Khalil P. Clinical review: liberation from mechanical ventilation. Crit Care 2008; 12:221. This review evaluates methods to assess whether patients are ready for extubation. It describes some of the downfalls associated with mechanical ventilation such as ventilator-induced lung injury and pneumonia and the longer hospital length of stay and cost.