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Perioperative management of children with neuromuscular disorders based on a common protocol: A prospective, national

Fabrizio Racca1, Yaroslava Longhitano1, Andrea Wolfler2

  • 1Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.

Acta Anaesthesiologica Scandinavica
|May 8, 2021
PubMed

Insights

Non-invasive ventilation (NIV) with mechanical insufflation-exsufflation (MI-E) effectively prevents postoperative pulmonary complications in children with neuromuscular diseases. This approach reduces PPCs and improves outcomes for these vulnerable patients.

Area of Science:

  • Pediatric Anesthesiology
  • Respiratory Medicine
  • Neuromuscular Diseases

Background:

  • Children with neuromuscular diseases (NMDs) face heightened risks of postoperative pulmonary complications (PPCs) due to respiratory muscle weakness.
  • Non-invasive ventilation (NIV) combined with mechanical insufflation-exsufflation (MI-E) is a promising strategy to mitigate these risks.

Purpose of the Study:

  • To evaluate a shared perioperative protocol using NIV and MI-E for NMD children.
  • To assess the impact of this protocol on postoperative outcomes in pediatric patients with NMDs.

Main Methods:

  • A multicenter, observational study involving 167 pediatric patients with NMDs across 13 Italian hospitals.
  • Data collected from December 2015 to December 2018, focusing on anesthetic procedures and postoperative respiratory support.

Main Results:

  • 89% of patients were at high risk for PPCs, with 51% dependent on preoperative ventilatory support.
  • Only 8% of patients developed PPCs, and only two required tracheostomy.
  • Patients with preoperative ventilatory support dependence had higher ICU admission rates and longer hospital stays.

Conclusions:

  • Disease severity, rather than procedure invasiveness, appears more strongly linked to patient outcomes.
  • NIV combined with MI-E is effective in preventing and resolving PPCs in pediatric NMD patients.
Abstract

Keywords:
anaesthesiamechanical cough deviceneuromuscular diseasesnon-invasive ventilationpostoperative respiratory complications

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