Ann Clin Anesth Res | Volume 2, Issue 1 | Research Article | Open Access
Yvonne Valzani2, Emanuele Rossetti1*, Francesca Tortora1, Rosanna Pariante1, Roberto Bianchi1 and Sergio Picardo1
1Department of Emergency-Anaesthesia and Intensive Care (DEA-ARCO), Bambino Gesù Children’s Hospital, Italy
2Department of Intensive Care Unit, University of Modena and Reggio Emilia, Italy
*Correspondance to: Emanuele Rossetti
Fulltext PDFPurpose: To analyse the correlation between intraoperative fluid therapy and immediate Helmet CPAP on length of conventional mechanical ventilation and length of stay in paediatric intensive care unit in children less than 1 year submitted to liver transplantation.Materials and
Methods: A retrospective, descriptive, single centre chart review analysis. Institutional review board approved the study. Inclusion criteria: 1) Children submitted to liver transplantation from January 2008 to October 2014 in our Department; 2) children over 1 month; 3) children less than 1 year. Exclusion criteria: 1) children submitted to liver–kidney transplantation or to multi-visceral transplantation; 2) Redo liver transplantation. From our medical records, we collected demographic data, indications to liver transplantation, paediatric end-stage liver disease score, intraoperative fluid administration, intraoperative diuresis, intraoperative perspiration, fluid balance at the end of surgery and need for non-invasive ventilation after extubation. We recorded days of conventional mechanical ventilation and length of stay in paediatric intensive care unit. We also recorded need for re-intubation. Statistical analysis was performed using Stata 10 ver. per Windows software. Data are expressed as median (max-min) and average ± Standard Deviation. Wilcoxon test was used to compare medians. P value <0.05 was considered as a statistically significant value.Results: The 38 children less than 1 year were submitted to liver transplantation from January 2008 to October 2014. Median age was 7.8 ± 3.2 months. Median weight was 6.8 ± 1.9 Kg. Average paediatric end-stage liver disease score was 27.2 ± 16.8. Male female ratio was 1.4:1. The most frequent indication to liver transplantation was biliary atresia (34 children less than 1 year). End surgery fluid balance resulted to be inferior for children submitted to orthotopic liver transplantation after December 2011. Children were divided into two groups according to this result. Furthermore, since 2011 early Helmet CPAP support increased progressively. We found that children under 1 year submitted to a restrictive intraoperative fluid management and treated with Helmet CPAP immediately after extubation showed better outcomes in terms of length of conventional mechanical ventilation and length of stay in paediatric intensive care unit.
Conclusion: According to our results and considering the limits of a retrospective cohort study, restrictive intraoperative fluid management and early post extubation Helmet CPAP seem to have relevant impact in paediatric liver transplantation postoperative outcome in terms of length of conventional mechanical ventilation and length of stay in paediatric intensive care unit. Further investigations are required to confirm these single centre experience findings.
Paediatric liver transplantation; Fluid management; Length of stay; Paediatric intensive care unit; Non-invasive ventilation
Valzani Y, Rossetti E, Tortora F, Pariante R, Bianchi R, Picardo S. Immediate Helmet Continuous Positive Airway Pressure to Deal Liver Transplantation in Infants Under 1 Year in Pediatric Intensive Care Unit. Ann Clin Anesth Res. 2018; 2(1): 1007.