Effect of total intravenous-based immediate extubation on patient outcomes in adult liver transplantation: A retrospective cohort study
Background: Although step-down emergence and extubation are universally practiced after liver transplantation (LT), prolonged mechanical ventilation and positive end-expiratory pressure may enhance predisposition to ventilator-associated complications and may be associated with inferior outcomes. Me...
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Elsevier
2025-01-01
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| author | Yan-Jun Chu Hui Zhang Bing-Xin Jin Yu-Fan Liu Yong-Xing Yao |
| author_facet | Yan-Jun Chu Hui Zhang Bing-Xin Jin Yu-Fan Liu Yong-Xing Yao |
| author_sort | Yan-Jun Chu |
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| description | Background: Although step-down emergence and extubation are universally practiced after liver transplantation (LT), prolonged mechanical ventilation and positive end-expiratory pressure may enhance predisposition to ventilator-associated complications and may be associated with inferior outcomes. Methods: We screened 339 patients who underwent LT in this retrospective cohort study. After propensity score matching, 35 patients in Group F (total intravenous-based immediate extubation, TIIE) and 107 patients in Group C (balanced anesthesia with step-down extubation) with balanced and comparable pre- and intraoperative profiles were selected for analysis. Patients in Group F received propofol- and remifentanil-based total intravenous anesthesia, followed by immediate tracheal extubation. Patients in Group C received sevoflurane-based balanced anesthesia and were step-down extubated in the intensive care unit. The primary outcomes were postoperative respiratory support time and length of postoperative ICU stay. Other postoperative outcomes were compared between the two groups. Results: Group F had significantly shorter postoperative respiratory support time than Group C (median, 0.08 vs 17 h; P < 0.001). The duration of postoperative intensive unit care stay in Group F was significantly shorter than that in Group C (mean, 5.84 vs 7.08 days; P = 0.019). Group F had a lower incidence of bacterial infection (20.0 % vs 42.1 %; P = 0.019) than Group C. No significant differences in continuous renal replacement therapy use (2.86 % vs 13.08 %; odds ratio, 0.195; P = 0.088), early mortality rate, percentage reduction of bilirubin, the incidence of exploratory laparotomy, pneumonia, or thrombosis were observed between groups. Conclusion: TIIE is safe, effective, and associated with a lower incidence of postoperative bacterial infection. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | Heliyon |
| spelling | doaj-art-a286077d4eef4ceda2f972623af0fbfd2025-02-02T05:28:59ZengElsevierHeliyon2405-84402025-01-01112e42108Effect of total intravenous-based immediate extubation on patient outcomes in adult liver transplantation: A retrospective cohort studyYan-Jun Chu0Hui Zhang1Bing-Xin Jin2Yu-Fan Liu3Yong-Xing Yao4Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of ChinaDepartment of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of ChinaDepartment of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of ChinaDepartment of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of ChinaDepartment of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China; Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China; Corresponding author. Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China.Background: Although step-down emergence and extubation are universally practiced after liver transplantation (LT), prolonged mechanical ventilation and positive end-expiratory pressure may enhance predisposition to ventilator-associated complications and may be associated with inferior outcomes. Methods: We screened 339 patients who underwent LT in this retrospective cohort study. After propensity score matching, 35 patients in Group F (total intravenous-based immediate extubation, TIIE) and 107 patients in Group C (balanced anesthesia with step-down extubation) with balanced and comparable pre- and intraoperative profiles were selected for analysis. Patients in Group F received propofol- and remifentanil-based total intravenous anesthesia, followed by immediate tracheal extubation. Patients in Group C received sevoflurane-based balanced anesthesia and were step-down extubated in the intensive care unit. The primary outcomes were postoperative respiratory support time and length of postoperative ICU stay. Other postoperative outcomes were compared between the two groups. Results: Group F had significantly shorter postoperative respiratory support time than Group C (median, 0.08 vs 17 h; P < 0.001). The duration of postoperative intensive unit care stay in Group F was significantly shorter than that in Group C (mean, 5.84 vs 7.08 days; P = 0.019). Group F had a lower incidence of bacterial infection (20.0 % vs 42.1 %; P = 0.019) than Group C. No significant differences in continuous renal replacement therapy use (2.86 % vs 13.08 %; odds ratio, 0.195; P = 0.088), early mortality rate, percentage reduction of bilirubin, the incidence of exploratory laparotomy, pneumonia, or thrombosis were observed between groups. Conclusion: TIIE is safe, effective, and associated with a lower incidence of postoperative bacterial infection.http://www.sciencedirect.com/science/article/pii/S2405844025004888Total-intravenous anesthesiaImmediate extubationBalanced anesthesiaLiver transplantationPostoperative infectionRetrospective |
| spellingShingle | Yan-Jun Chu Hui Zhang Bing-Xin Jin Yu-Fan Liu Yong-Xing Yao Effect of total intravenous-based immediate extubation on patient outcomes in adult liver transplantation: A retrospective cohort study Heliyon Total-intravenous anesthesia Immediate extubation Balanced anesthesia Liver transplantation Postoperative infection Retrospective |
| title | Effect of total intravenous-based immediate extubation on patient outcomes in adult liver transplantation: A retrospective cohort study |
| title_full | Effect of total intravenous-based immediate extubation on patient outcomes in adult liver transplantation: A retrospective cohort study |
| title_fullStr | Effect of total intravenous-based immediate extubation on patient outcomes in adult liver transplantation: A retrospective cohort study |
| title_full_unstemmed | Effect of total intravenous-based immediate extubation on patient outcomes in adult liver transplantation: A retrospective cohort study |
| title_short | Effect of total intravenous-based immediate extubation on patient outcomes in adult liver transplantation: A retrospective cohort study |
| title_sort | effect of total intravenous based immediate extubation on patient outcomes in adult liver transplantation a retrospective cohort study |
| topic | Total-intravenous anesthesia Immediate extubation Balanced anesthesia Liver transplantation Postoperative infection Retrospective |
| url | http://www.sciencedirect.com/science/article/pii/S2405844025004888 |
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