2011 - ISBTS 2011 Symposium


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Oral Communications 9: Psychosocial Outcomes & Quality of Life

12.213 - Post-transplant critical care outcomes for pediatric intestinal transplant patients

Presenter: Mara, Nitu, Indianapolis, United States
Authors: Courtney Rowan2, Mara Nitu2, Richard Speicher2, Rodrigo M Vianna1, A. Joseph Tector1, Chekar Kubal1, Richard S. Mangus1

213
Post-transplant critical care outcomes for pediatric intestinal transplant patients

Courtney Rowan2, Mara Nitu2, Richard Speicher2, Rodrigo M Vianna1, A. Joseph Tector1, Chekar Kubal1, Richard S. Mangus1

1Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States; 2Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States

Background: There is limited data describing pediatric post-intestine transplant critical care management. Care at our center is managed in a multidisciplinary fashion between the transplant team and the pediatric intensive care unit (PICU) team. This study reviews the post-operative management of pediatric intestinal transplant patients at a single center with reporting of standard PICU benchmarks for quality of care.

Methods: This study is a retrospective, descriptive, chart review describing our institution’s experience between 2006 and 2010. For each patient, the complete data for the PICU admission were collected including demographic information, PICU length of stay, ventilator days, incidence of and reasons for extubation failure, sedation requirements, pain management, initiation and management of nutrition, use of vasopressor agents, glucose control, diuretic therapy, and adverse events.

Results: Twenty patients were included in this study, 16 multivisceral and 4 isolated intestine patients. Median age at transplant was 12 months. Median length of PICU stay was 10 days (mean 14 days). Median ventilation time was 1 day (mean 2.9). Median time for continuous sedation infusion was 2 days (mean 3 days), with median continuous pain medication infusion of 3 days (mean 6.4). All patients were placed on parental nutrition (PN) immediately post-transplant, and started on enteral feedings between days 3 and 4. Forty percent of patients required hemodynamic support, but total duration was limited (1.5 days). Even with pancreatic transplantation, only 35% of patients required insulin therapy. Diuretic therapy was frequently used in this patient population, with 65% requiring furosemide at some point during their PICU stay. There were no episodes of early rejection. There was 1 death 6 days post-transplant related to overwhelming sepsis (survival rate to PICU discharge of 95%).

Conclusions: Pediatric intestinal transplantation remains a small volume procedure throughout the world. However, with improving outcomes, an increasing number of centers have begun to perform this procedure. As such, the pediatric intensivists’ exposure to these patients will also increase. Our institution’s experience over the past 4 years has been very successful with a short duration of mechanical ventilation, limited use of pain and sedation drips, early initiation of enteral feedings, minimal hemodynamic support, and a low mortality rate to PICU discharge despite a preponderance of complex multivisceral transplant recipients.


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