Author Of 1 Presentation
POSTOPERATIVE RESPIRATORY FAILURE IN PEDIATRIC LIVER RECIPIENTS: DETERMINANTS AND ROLE OF NONINVASIVE CPAP.
- Fabrizio Chiusolo, Italy
- Linda Appierto,
- Marta Luisa Ciofi Degli Atti,
- Luigi Dei Giudici,
- Ilaria Erba,
- Ivano Farinelli,
- Alessandro Germani,
- Chiara Grimaldi,
- Francesco Polisca,
- Lucilla Rava',
- Emanuele Rossetti,
- Marco Spada,
- Francesca Tortora,
- Rosanna Pariante,
- Roberto Bianchi,
- Sergio Giuseppe Picardo,
Abstract
Background
Postoperative respiratory failure (RF) after pediatric liver transplantation (LT) is associated to high rate of morbidity and mortality due to this procedure. Use of noninvasive ventilation (NIV) for management of RF in postoperative period is debated.
Objectives
Evaluate perioperative risk factors of RF treated with CPAP in pediatric patients undergone LT.
Methods
Single center retrospective experience. Population was divided in two group based on the need of NIV after extubation. Preoperative, intraoperative and postoperative variables were collected to understand determinants of RF treated by CPAP by multivariate logistic model.
Results
In this retrospective cohort, 172 pediatric patients undergone to LT. Ninety four patients (94/172) developed RF after extubation and were treated with helmet CPAP. No differences were found between the two groups for type of graft, donor, surgical complications, infection rate. Patients treated with CPAP received more blood transfusion, and abdominal mesh wall was inserted. At multivariate analysis, biliary atresia (OR=3.6, 95% CI 1.3-9.8, p=.01), PELD>22 (OR=1.03; 95% CI 1.0-1.07, p=.02) and use of vasopressors during intraoperative period (OR=2.9; 95% CI 1.4-6.0, p=.005) expose pediatric liver recipient to development of postoperative RF treated with CPAP. Weight > 10 kg (OR=0.9, 95% CI 0.93-0.99, p=.03) could reduce the risk of postoperative RF. In the NIV group rate of intubation for NIV failure was 7.4% (7/94).
Conclusion
Biliary atresia, PELD>22 and use of intraoperative inotropes/vasopressors expose pediatric liver recipients to a greater odds of developing postoperative RF. CPAP application in early post-transplant period may be a good choice to treat postoperative RF after major abdominal surgery.