Patient selection: orthotopic liver transplant
Outcome: prolonged mechanical ventilation in the early postoperative period
Risk factors:
(1) severe intraoperative hemorrhage
(2) low urine output during surgery
(3) postoperative renal failure
The typical patient with prolonged mechanical ventilation follows a sequence:
(1) massive blood loss during surgery
(2) onset of renal insufficiency
(3) massive blood and fluid replacement with fluid overload
(4) pulmonary edema
Ways to reduce the risk of this happening:
(1) minimize intraoperative blood loss
(2) monitoring hemostasis during surgery and rapidly correcting any problems
(3) minimize fluid infusion and use of blood products
(4) properly administer vasoactive (vasoconstricting and pressor) drugs
