Pulmonary complications are an important cause of the mortality associated with liver transplantation. The efficacy of noninvasive ventilation (NIV) in pediatric patients following transplantation is unknown. The purpose of this retrospective study is to investigate the effects of NIV for pediatric patients undergoing liver transplantation. Of 102 pediatric patients who underwent liver transplantation, 15 patients (aged 73 months; range 2.5-179) were supported by NIV because of atelectasis, hypercapnia, hypoxemia, pneumonia, massive effusion, or postextubation ventilatory support. Of 15 patients, 5 were under the age of 1 year (range 2.5-12 months). Of the 15 patients, 7 had required multiple intubations before NIV treatment because of pulmonary complications. NIV treatment was administered to 6 patients because of hypercapnia. Partial pressure of arterial carbon dioxide (PaCO 2 ) levels improved from 56.9 (95% confidence interval [CI]: 48.4-65.4) to 41.5 (95% CI: 36.8-46.2) mmHg (P ؍ .028) within 2 days. NIV treatment was very effective for patients with atelectasis with and without other pulmo-nary complications. Mean inspiratory positive pressure (IPAP) was 7.2 (95% CI: 6.0-8.3) cm H 2 O and expiratory positive pressure (EPAP) was 3.5 (95% CI: 3.2-3.9) cm of H 2 O. Mean duration of NIV was 18.5 (95% CI: 8.6-28.4) days. IPAP and EPAP levels were closely and significantly correlated with height (IPAP: r ؍ .65, P ؍ .016; EPAP: r ؍ .77, P ؍ .004). A total of 13 patients recovered and 2 patients died. However, no patient died of respiratory complications. In conclusion, NIV is effective in pediatric patients undergoing liver transplantation with subsequent pulmonary complications. The IPAP and EPAP levels may be predicted by the height of the patient. (Liver Transpl 2005;11:188-195.)
T he number of recipients of solid organ transplan- tation is growing. Pulmonary complications are an important cause of illness in patients after transplantation 1 and contribute substantially to the mortality associated with various types of immunosuppression. For acute postoperative respiratory failure, initial treatment is with oxygen and physiotherapy in an attempt to avoid endotracheal intubation, which is the single most important predisposing factor for development of nosocomial bacterial pneumonia. 2 Recently, it was reported that the early application of noninvasive ventilation (NIV) in solid organ transplant recipients and in immunosuppressed patients could eliminate the need for intubation. 3,4 However, in both reports, the patients were adults. Although it has been reported that ventilatory support can be provided noninvasively to infants and small children as well as to adults with neuromuscular disease, 5,6 the effects of NIV on pediatric patients, especially those under 1 year of age, after solid organ transplantation or otherwise immunosuppressed, have not been published. 7 Due to the lack of reports on NIV for respiratory complications following pediatric solid organ transplantation and the increasing number of pediatric transplants, including living donor liver transplantation, the role of NIV deserves attention. We hypothesized that NIV was useful for the management of lung complications in children following liver trans-Abbreviations: NIV, noninvasive ventilation; PaCO 2 , partial pressure of arterial carbon dioxide; CI,