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

doi:10.1097/PCC.0000000000003101

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

Pediatric Critical Care Medicine

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

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 language	English (US)
Pages (from-to)	102-111
Number of pages	10
Journal	Pediatric Critical Care Medicine
Volume	24
Issue number	2
DOIs	https://doi.org/10.1097/PCC.0000000000003101
State	Published - 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.

Keywords

artificial respiration
critical care
liver transplantation
pediatrics
respiratory insufficiency
transplants

PubMed: MeSH publication types

Multicenter Study
Journal Article

Publisher link

10.1097/PCC.0000000000003101

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Maue, D. K., Martinez, M., Alcamo, A., Beltramo, F., Betters, K., Nares, M., Jeyapalan, A., Zinter, M., Kamath, S., Ridall, L., Monde, A., Resch, J., Kaushik, S., Kang, E., Mangus, R. S., Pike, F., & Rowan, C. M. (2023). Critical Care and Mechanical Ventilation Practices Surrounding Liver Transplantation in Children: A Multicenter Collaborative∗. Pediatric Critical Care Medicine, 24(2), 102-111. https://doi.org/10.1097/PCC.0000000000003101

Maue, DK, Martinez, M, Alcamo, A, Beltramo, F, Betters, K, Nares, M, Jeyapalan, A, Zinter, M, Kamath, S, Ridall, L, Monde, A, Resch, J, Kaushik, S, Kang, E, Mangus, RS, Pike, F & Rowan, CM 2023, 'Critical Care and Mechanical Ventilation Practices Surrounding Liver Transplantation in Children: A Multicenter Collaborative∗', Pediatric Critical Care Medicine, vol. 24, no. 2, pp. 102-111. https://doi.org/10.1097/PCC.0000000000003101

@article{e9696ed47256400db57dd03efdbd4eda,

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

abstract = "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.",

keywords = "artificial respiration, critical care, liver transplantation, pediatrics, respiratory insufficiency, transplants",

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

note = "Funding Information: Dr. Zinter{\textquoteright}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{\textquoteright}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: {\textcopyright} Copyright 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.",

year = "2023",

month = feb,

day = "1",

doi = "10.1097/PCC.0000000000003101",

language = "English (US)",

volume = "24",

pages = "102--111",

journal = "Pediatric Critical Care Medicine",

issn = "1529-7535",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "2",

}

TY - JOUR

T1 - Critical Care and Mechanical Ventilation Practices Surrounding Liver Transplantation in Children

T2 - A Multicenter Collaborative∗

AU - Maue, Danielle K.

AU - Martinez, Mercedes

AU - Alcamo, Alicia

AU - Beltramo, Fernando

AU - Betters, Kristina

AU - Nares, Michael

AU - Jeyapalan, Asumthia

AU - Zinter, Matthew

AU - Kamath, Sameer

AU - Ridall, Leslie

AU - Monde, Alexandra

AU - Resch, Joseph

AU - Kaushik, Shubhi

AU - Kang, Elise

AU - Mangus, Richard S.

AU - Pike, Francis

AU - Rowan, Courtney M.

N1 - 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.

PY - 2023/2/1

Y1 - 2023/2/1

N2 - 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.

AB - 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.

KW - artificial respiration

KW - critical care

KW - liver transplantation

KW - pediatrics

KW - respiratory insufficiency

KW - transplants

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U2 - 10.1097/PCC.0000000000003101

DO - 10.1097/PCC.0000000000003101

M3 - Article

C2 - 36278882

AN - SCOPUS:85146875268

SN - 1529-7535

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JO - Pediatric Critical Care Medicine

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ER -

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

Abstract

Bibliographical note

Keywords

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