Immediate vs delayed extubation after pediatric liver transplantation: a systematic review and meta-analysis.
Marco Daverio, Goda Laucaityte, Matthew A Goldstein et al.
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In 30 seconds
This systematic review and meta-analysis compared immediate operating-room extubation with delayed extubation after pediatric orthotopic liver transplantation. It included 12 retrospective, single-centre studies, comprising 1323 patients (1158 unique children after accounting for cohort overlap). Immediate extubation was associated with lower odds of reintubation (OR 0.32, 95% CI 0.17-0.59) and mortality (OR 0.35, 95% CI 0.18-0.68), as well as shorter PICU and hospital stays. No significant differences were found for thrombosis or reoperation. The authors caution that selection bias prevents causal conclusions.
Key findings
- Immediate extubation was associated with lower odds of reintubation (OR 0.32, 95% CI 0.17-0.59).
- Mortality odds were lower with immediate extubation (OR 0.35, 95% CI 0.18-0.68).
- Immediate extubation was associated with shorter PICU LOS (SMD - 0.88, 95% CI - 1.39 to - 0.37) and hospital LOS (SMD - 1.16, 95% CI - 2.00 to - 0.31).
- No significant differences were observed for thrombosis or reoperation.
Why it matters
Extubation timing after pediatric liver transplantation may be relevant to postoperative respiratory outcomes and length of stay. The pooled findings suggest immediate extubation is feasible in selected children, but children extubated immediately may have been older and in better preoperative condition. The observed outcome differences therefore should not be interpreted as proof that immediate extubation itself improves outcomes.
What to keep in mind
All included studies were retrospective and single-centre, with high risk of selection bias. Cohort overlap was present, and confounding is a particular concern for hospital length of stay; causality cannot be established.