Critical Care and Mechanical Ventilation Practices Surrounding Liver Transplantation in Children: A Multicenter Collaborative∗

Danielle K. Maue, Mercedes Martinez, Alicia Alcamo, Fernando Beltramo, Kristina Betters, Michael Nares, Asumthia Jeyapalan, Matthew Zinter, Sameer Kamath, Leslie Ridall, Alexandra Monde, Joseph Resch, Shubhi Kaushik, Elise Kang, Richard S. Mangus, Francis Pike, Courtney M. Rowan

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


OBJECTIVES: We aimed to determine which characteristics and management approaches were associated with postoperative invasive mechanical ventilation (IMV) and with a prolonged course of IMV in children post liver transplant as well as describing the utilization of critical care resources. DESIGN: Retrospective, multicenter, cohort study of children who underwent an isolated liver transplantation between January 2017 and December 2018. SETTING: Twelve U.S., pediatric, liver transplant centers. PATIENTS: Three hundred thirty children post liver transplant admitted to the ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Six patients died in our cohort. The median length of PICU stay was 4.5 days (interquartile range [IQR], 2.9-8.2 d). Most patients were initially monitored with arterial catheters (96%), central venous pressures (95%), and liver ultrasound (93%). Anticoagulation (80%), blood product administration (52.4%), and vasoactive agents (23.0%) were commonly used therapies in the first 7 days. In multivariable logistic regression analysis, age (adjusted odds ratio [aOR] 0.9 [0.86-0.95]), open fascia (aOR 7.0 [95% CI, 2.6-18.9]), large center size (aOR 4.3 [95% CI 2.2-8.3]), and higher Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease scores (aOR 1.04 [95% CI, 1.01-1.06]) were associated with postoperative IMV. In multivariable logistic regression analysis, postoperative day 0 peak inspiratory pressure (PIP) (aOR 1.2 [95% CI, 1.1-1.3]), large center size (aOR 2.9 [95% CI, 1.6-5.4]), and age (aOR 0.89 [95% CI, 0.85-0.95]) were associated with length of IMV greater than 24 hours. Length of IMV greater than 24 hours was associated with bleeding complications (p = 0.03), infections (p = 0.03), graft loss (p = 0.02), and reoperation (p = 0.03). CONCLUSIONS: Younger age, preoperative hospitalization, large center size, and open fascia are associated with use of IMV, and younger age, large center size, and postoperative day 0 PIP are associated with prolonged IMV on multivariable analysis. Longer IMV is associated with negative outcomes, making it an important clinical marker.

Original languageEnglish (US)
Pages (from-to)102-111
Number of pages10
JournalPediatric Critical Care Medicine
Issue number2
StatePublished - Feb 1 2023

Bibliographical note

Funding Information:
Dr. Zinter’s institution received funding from the National Heart, Lung, and Blood Institute (NHLBI) (K23HL146936). Drs. Zinter and Rowan received support for article research from the National Institutes of Health (NIH). Dr. Mangus received funding from F. Kohler-Chemie. Dr. Rowan’s institution received funding from the NHLBI K23; she received funding from the NIH (K23HL150244). The remaining authors have disclosed that they do not have any potential conflicts of interest.

Publisher Copyright:
© Copyright 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.


  • artificial respiration
  • critical care
  • liver transplantation
  • pediatrics
  • respiratory insufficiency
  • transplants

PubMed: MeSH publication types

  • Multicenter Study
  • Journal Article


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