Edorium Journal of

Anesthesia

 
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Short Report
 
Fast-tracking of adult patients following liver transplantation
Caroline Pocknall1, Jelena Marinkovic2, Zoka Milan3
1Anaesthetic ST6, Anaesthetic Department, King's College Hospital, London, UK.
2Professor of Statistics, Belgrade School of Medicine, Serbia.
3Consultant Anaesthetist, Honorary Senior Lecturer, Visiting Professor, King's College Hospital, London, UK.

Article ID: 100006A05CP2016
doi:10.5348/A05-2016-6-SR-2

Address correspondence to:
Caroline Clare Pocknall
Anaesthetic Department, King's College Hospital
Denmark Hill
London, SE5 9RS

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How to cite this article
Pocknall C, Marinkovic J, Milan Z. Fast-tracking of adult patients following liver transplantation. Edorium J Anesth 2016;2:6–9.


Abstract
Introduction: Fast-tracking of adult patients following liver transplantation has in the past been based on clinical decision making. A recent comprehensive scoring system from a single centre has a successful fast-tracking probability score of up to 92%. At our institution we used the same scoring system for research, to identify those patients who might be suitable for fast-tracking after liver transplantation and correlated their score with actual duration of postoperative mechanical ventilation and their preoperative (CPET) cardiopulmonary exercise testing scores.
Short Report: A retrospective audit of 30 consecutive adult patients undergoing liver transplantation was carried out over a 3- month period. Patients in acute liver failure and those who were ventilated preoperatively were excluded. A score for each patient was calculated based on age, gender, body mass index, MELD (model for end-stage liver disease) score, pretransplant length of stay, transplant number, intraoperative volume of red blood cell transfusion, operative time and vasopressor use in the last hour of surgery. Preoperative CPET scores were recorded along with duration of mechanical ventilation post-operatively. Thirty-three percent of the patients achieved a fast-track score associated with a successful predictor of fast-tracking, i.e., early extubation. These results showed a statistically significant association between fast-track score and actual time of postoperative mechanical ventilation. Preoperative CPET scores did not correlate with the fast-track score or duration of mechanical ventilation.
Conclusion: A fast-track scoring system can be used to identify adult patients that are suitable for fast-tracking following liver transplantation surgery. This may reduce length of mechanical ventilation and ultimately reduce financial costs.

Keywords: Early extubation, Fast-tracking, Liver, Transplantation


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Author Contributions:
Caroline Pocknall – Acquisition of data, Drafting the article, Final approval of the version to be published
Jelena Marinkovic – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Zoka Milan – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Caroline Pocknall et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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