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