Factors Affecting Early and Late Extubation in Liver Transplant Patients

Background: Tracheal extubation is a critical stage and expensive practice in patients undergoing major operations such as liver transplantation. This study was carried out to determine factors affecting extubation time in liver transplant patients. Methods: From 2003 to 2006, all patients undergoing liver transplantation in Nemazee Hospital affiliated to Shiraz University of Medical Sciences were enrolled. All patients were anesthetized identically and the time of extubation was based on standard protocol of extubation. The patients were divided into two groups of extubated after admission in less (Group 1) and more than (Group 2) four hours. The effect of 19 pre and post operative factors on extubation was also evaluated. Results: Two hundred patients (Group 1=121; Group 2=79) entered the study. A significant correlation was noticed for bleeding during operation, abnormal blood pressure more than 30 minutes at the end of surgery and duration of operation. A rise in extubation time was observed when duration of surgery increased. In ICU, 37 patients needed reintubation among them 23 were in Group 2 and 14 in Group 1. The most common causes of reintubation were insufficient oxygenation, repeated laparatomy and decrease in consciousness level. The mean days of ICU staying in early and late extubation groups were 4.16 and 6.04 days (p=0.001). Conclusion: It seems that duration of surgery, bleeding during operation and an abnormal blood pressure may delay the time of extubation. An early extubation may result into a decrease in duration of ICU admission too.