Influence of early extubation on post‐operative outcomes after pediatric lung transplantation

• Published in: Pediatric transplantation Vol. 25; no. 2; pp. e13776 - n/a
• Main Authors: Labarinas, Sonia, Coss‐Bu, Jorge A., Onyearugbulem, Chinyere, Heinle, Jeffery S, Mallory, George B, Gazzaneo, Maria C.
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01-03-2021
• Subjects: Adolescent; Airway Extubation - economics; Airway Extubation - methods; Child; Child, Preschool; Cystic fibrosis; early extubation; Extubation; Female; Hospital costs; Hospital Costs - statistics & numerical data; Humans; Infant; Infant, Newborn; Length of Stay - economics; Length of Stay - statistics & numerical data; Lung diseases; Lung transplantation; Lung Transplantation - economics; Male; Mechanical ventilation; Outcome Assessment, Health Care; Patients; pediatric lung transplantation; Pediatrics; Postoperative Care - economics; Postoperative Care - methods; Retrospective Studies; Texas; Transplants & implants; Ventilation; Young Adult; Texas; United States > US; hospital costs; pediatric lung transplantation; early extubation
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/petr.13776

Lung transplantation has become an accepted therapeutic option for a select group of children with end‐stage lung disease. We evaluated the impact of early extubation in a pediatric lung transplant population and its post‐operative outcomes. Single‐center retrospective study. PICU within a tertiary academic pediatric hospital. Patients <22 years after pulmonary transplant between January 2011 and December 2016. A total of 74 patients underwent lung transplantation. The primary pretransplantation diagnoses included cystic fibrosis (58%), pulmonary fibrosis (9%), and surfactant dysfunction disorders (10%). Of 60 patients, 36 (60%) were extubated within 24 hours and 24 patients after 24 hours (40%). A total of seven patients (11.6%) required reintubation within 24 hours. Median length of stay for the early extubation group was shorter at 3 days ([(IQR) 2.2‐4.7]) compared to 5 days (IQR, 3‐7) (P = .02) in the late extubation group. Median costs were lower for the early extubation group with 13,833 US dollars (IQR, 9980‐22,822) vs 23 671 US dollars (IQR, 16 673‐39 267) (P = .043). Fourteen patients were in the PICU prior to their transplantation; this did not affect their early extubation success. Neither did the fact of requiring invasive or non‐invasive mechanical ventilation before transplantation. Early extubation appears to be safe in a pediatric population after lung transplantation and is associated with a shorter LOS and decreased hospital costs. It may prevent known complications associated with mechanical ventilation.