Perioperative risk factors for prolonged mechanical ventilation after liver transplantation due to acute liver failure

Application and assessment of NNN linkages in liver transplant postoperative care: a prospective study

BACKGROUND

Standardized nursing frameworks are widely used to unify nursing practices and enhance patient outcomes, but their application in liver transplantation is still limited. This study evaluates the use of NANDA-I, NOC, and NIC linkages in the perioperative care of liver transplant recipients, aiming to inform future nursing practice improvements.

METHODS

This prospective observational cohort study (December 2022-August 2023) included 44 liver transplant recipients using consecutive sampling. The Delphi method refined the NANDA-I, NOC, and NIC (NNN) linkage framework to 15 nursing diagnoses, 42 outcomes, and 106 interventions. Postoperative NOC indicators were assessed on surgery day and postoperative days 3, 7, 14, and at discharge. One-way repeated measures ANOVA, with Greenhouse-Geisser correction for sphericity violations, analyzed the indicators.

RESULTS

Twelve nursing diagnoses had a 100% usage rate, with an average intervention usage rate of 96.59%. Nine diagnoses showed consistent improvement in NOC scores across four time points, with significant differences (P < 0.008). In contrast, five diagnoses displayed fluctuating scores, highlighting the need for targeted interventions.

CONCLUSIONS

The NNN linkages effectively tracked postoperative changes and guided care for liver transplant patients. The findings support refining nursing care protocols to address fluctuating outcomes and improve patient recovery.

Influence of Hospice Palliative Care on Medical Service Usage in Prolonged Mechanical Ventilation Cases: A Nationwide Cohort Study

BACKGROUND

Numerous studies have demonstrated that hospice palliative care interventions for cancer patients can reduce health care utilzation. In Taiwan, 20-25% of patients who require mechanical ventilation are using prolonged mechanical ventilation (PMV); however, only a limited number of studies have addressed the effectiveness of hospice palliative care for these patients. This study investigated the impact of hospice palliative care utilization on medical utilization among subjects using PMV.

METHODS

By using the health insurance database of a nationwide population-based study, we identified subjects who had been on mechanical ventilation for > 21 d, were age ≥18 y between 2009 and 2017, and had received hospice palliative care. The control group was formed through 1:1 matching by using propensity scoring after excluding patients who had participated in palliative care for <15 d or for >181 d. Furthermore, we used a conditional logistic regression analysis to investigate the incidence of ICU admission, emergency department presentation, and cardiopulmonary resuscitation within 14 d before death.

RESULTS

A total of 186,533 new subjects receiving PMV age ≥ 18 y were admitted between 2009 and 2017. In addition, the number of subjects receiving palliative care increased annually, rising from 0.6% in 2009 to 41.33% in 2017. The emergency department visits (odds ratio [OR] 0.68, 95% CI 0.63-0.74), ICU admission (OR 0.59, 95% CI 0.53-0.66), cardiopulmonary resuscitation (OR 0.40, 95% CI 0.35-0.46), and total hospitalization cost ($1,319.91 ± $1,821.66 versus $1,544.37 ± $2,309.27 [$USD], P < .001) were significant lower in the palliative care group.

CONCLUSIONS

Subjects undergoing PMV while receiving hospice palliative care experienced significant reductions in total hospitalization costs, ICU admissions, cardiopulmonary resuscitation, and medical expenses within 14 d before death.

The Edge of Unknown: Postoperative Critical Care in Liver Transplantation

Perioperative care of patients undergoing liver transplantation (LT) is very complex. Metabolic derangements, hypothermia, coagulopathy and thromboses, severe infections, and graft dysfunction can affect outcomes. In this manuscript, we discuss several perioperative problems that can be encountered in LT recipients. The authors present the most up-to-date information regarding predicting and treating hemodynamic instability, coagulation monitoring and management, postoperative ventilation strategies and early extubation, management of infections, and ESLD-related pulmonary complications. In addition, early post-transplant allograft dysfunction will be discussed.

Utility of percutaneous dilatational tracheostomy in the inmediate postoperative period of liver transplant

OBJECTIVE

To determinate the safety of percutaneous dilatational tracheostomy (PDT) on hepatic allograft recipients.

PATIENTS AND METHODS

We reviewed the records of patients who underwent liver transplantation between October 2007 and April 2013, followed by PDT. In this time period, 25 liver recipients underwent PDT in our intensive care unit. We recorded severity index scores such as APACHE II and SAPS II, number of days since intubation, ratios of PaO2/FiO2 (arterial oxygen pressure to fraction of inspired oxygen), coagulation study findings, complications, and procedure-related mortality rates. We compared these records with the general ICU population and literature reports.

RESULTS

The median age was 58 (IC range 47-65) and 64% were men. The median time since intubation to PDT was 11 days (IC range 6.5-15.5) and from transplant to PDT 12 days. The median ratio of PaO2/FiO2 was 212 (IC range 177-259). The median platelet count was 89 (IC range 37-149), significantly lower than the general ICU population (272 (IC range 186-381) P=.001). Complications were infrequent and included clinically remarkable major bleeding 8% (vs. 0,3% in general ICU population; P=.005), peristomal infection (4%) and ventilator-associated pneumonia 16% (vs. 2,8% in general ICU population; P=.007). There were no deaths associated with the procedures.

CONCLUSION

PDT was tolerated well in recipients of liver allografts and had a relatively low risk of major complications and a low procedure-related mortality rate.