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Protocol-driven early tracheal extubation in patients with flaccid neuromuscular scoliosis and pre-existing lung disease

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Abstract

Purpose

To review the results of a postoperative respiratory pathway for patients with muscular dystrophy (MD) and spinal muscular atrophy (SMA) undergoing spinal surgery.

Methods

With IRB approval, a retrospective review was done on all patients with SMA and MD undergoing spinal surgery on a neuromuscular protocol. Baseline demographics, perioperative results, and long-term outcomes were collected. Per the protocol, patients remained intubated after surgery and were transported to the intensive care unit (ICU) for extubation. We present the results of protocol implementation and compare patients with MD to those with SMA.

Results

Twenty-four patients were treated using the protocol. Average age was 13.1 years. Severe restrictive lung disease was present in 75% of patients. Nocturnal BiPAP was required in 68% of patients. Average number of instrumented levels was 17. All patients were immediately extubated upon entering the ICU. There were three respiratory complications and only was patient was re-intubated. Average ICU stay was 1.8 days and average hospital length of stay was 6.7 days. No differences in postoperative inspiratory or expiratory positive airway pressures were observed between the MD and SMA groups.

Conclusion

Through a multidisciplinary neuromuscular protocol, excellent clinical outcomes were achieved in patients with neuromuscular scoliosis and restrictive lung disease, with complication rates and length of stay significantly lower than previously published data.

Level of evidence

IV.

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Data availability

Data are available from the corresponding author upon reasonable request.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Jeffrey Hatef

  2. Department of Orthopedic Surgery, Nationwide Children’s Hospital; Department of Orthopaedics, The Ohio State University Wexner Medical Center, The Ohio State University, 241 W. 11th Ave, Suite 6081, Columbus, OH, 43210, USA

    Jeffrey Hatef, Sarah Hatef, Joseph P. Drain, Allan Beebe, Walter Samora & Jan Klamar

  3. Ohio State University College of Medicine, Columbus, OH, USA

    Sarah Hatef

  4. Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, USA

    Joseph D. Tobias & David Martin

  5. Department of Pulmonary Medicine, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, USA

    Richard Shell

  6. Division of Pediatric Critical Care Medicine, Department Clinical Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, USA

    Margaret Chase

Authors
  1. Jeffrey Hatef
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  2. Sarah Hatef
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  3. Joseph P. Drain
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  4. Joseph D. Tobias
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Contributions

Conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work: JH, SH, JD, JT, DM, RS, MC, AB, WS, JK. Drafted the work or revised it critically for important intellectual content: JH, SH, JD, JT, DM, RS, MC, AB, WS, JK. Approved the version to be published: JH, SH, JD, JT, DM, RS, MC, AB, WS, JK. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: JH, SH, JD, JT, DM, RS, MC, AB, WS, JK.

Corresponding author

Correspondence to Joseph P. Drain.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by our institutional review board.

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This retrospective review did not require patient consent.

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This retrospective review did not require patient consent.

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Hatef, J., Hatef, S., Drain, J.P. et al. Protocol-driven early tracheal extubation in patients with flaccid neuromuscular scoliosis and pre-existing lung disease. Spine Deform 10, 689–696 (2022). https://doi.org/10.1007/s43390-021-00411-6

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  • DOI: https://doi.org/10.1007/s43390-021-00411-6

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