Optimum Timing for Postoperative Tracheal Extubation after Liver Transplantation

Abstract

Historically, patients undergoing liver transplantation have been recovered in intensive care units (ICUs) following surgery to ensure a smooth transition through the recovery period. However, as surgical and anesthetic techniques have improved, a growing number of centers worldwide have begun the practice of early extubation following transplantation. Some centers have even developed processes allowing select patients to completely bypass the ICU and be directly admitted to the surgical ward after transplantation (Aniskevich and Pai, 2015). Improvements in preoperative workups, surgical techniques, and perioperative and postoperative care have made early extubation following liver transplantation (LT) a feasible and safe procedure for a significant proportion of patients. Early extubation has physiological advantages over prolonged mechanical ventilation, including increased venous return to the heart, increased cardiac output, and increased hepatic blood flow. All of these factors contribute to increasing patient and graft survival, shortening hospital stay, and reducing treatment costs (Elnour and Milan, 2015).