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G388(P) Earlier extubation is associated with a reduction in early post-operative complications in children undergoing surgery for non-idiopathic spinal deformity
  1. CM McDougall1,2,
  2. H McPherson1,
  3. P Cowie3,
  4. J McFadzean1,3
  1. 1Paediatric Intensive Care, Royal Hospital for Sick Children, Edinburgh, UK
  2. 2Paediatric Respiratory Medicine, Royal Hospital for Sick Children, Edinburgh, UK
  3. 3Paediatric Anaesthesia, Royal Hospital for Sick Children, Edinburgh, UK

Abstract

Introduction and aims Surgical correction of non-idiopathic spinal deformities in children presents a challenge to intensivists because of the extensive nature of the surgery and co-morbidities of the patients. The postoperative management of such patients has not been standardised. Following a review of our practice,1 we have implemented a strategy of earlier extubation in those patients requiring post-operative ventilatory support, including increased use of non-invasive ventilation (NIV). This study aimed to assess the impact of this change in practice.

Methods All patients admitted to PICU following surgery for non-idiopathic spinal deformity were identified from the PICANet database for the time periods: (1) 1.1.07–31.12.08 (n = 64) and (2) 1.9.10–31.8.13 (n = 137). Details of the post-operative courses were obtained from the hospital casenotes and the PICU clinical information system.

Results The cohorts were similar with respect to age (mean (SD) 13.0(3.3) years v 12.8(4.2) years, p = 0.70), gender (male 52% v 47%, p = 0.77) and proportion of patients with neuromuscular curve (53% v 46%, p = 0.43). A similar proportion received invasive ventilation (IV) in PICU (42% v 49%, p = 0.52) but the duration of IV was significantly shorter in the more recent cohort (median (IQR) 41(77.5) hours v 20(23) hours, p = 0.004). 11(17%) patients received NIV in cohort 1 compared to 45(33%) in cohort 2 (p = 0.07). The total duration of respiratory support was reduced in cohort 2 but this did not reach statistical significance (median 4.0(8.2) v 2.4(4.6) days, p = 0.20). Postoperative complications occurred in 26(41%) cases in cohort 1 and 37(27%) in cohort 2 (p = 0.04), with a trend to reduced gastrointestinal complications in cohort 2 (16% v 9% patients, p = 0.11). Median duration of post-operative hospital admission was 9(9) days in cohort 1 and 10(6) days in cohort 2 (p = 0.50).

Conclusions Early extubation, facilitated by use of NIV, is associated with a reduction in early post-operative complications. Other factors impacting the post-operative course require further study so that the pathway for these complex patients can be further refined.

Reference

  1. McDougall C, McFadzean J. Post-operative respiratory support following surgery for non-idiopathic spinal deformity in children. Pediatr Crit Care Med. 2011;12(Suppl):A119

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