DG Journal Club
Paediatr Anaesth. 2021 Dec 5
Children with neruromuscular, chronic neurologic and chest wall diseases are at increased risk of post-operative respiratory complications including atelectasis, pneumonia, respiratory failure with the possible need for reintubation or even tracheostomy. These complications negatively impact patient outcomes, including increased healthcare resource utilization and increased surgical mortality. In these children, existing respiratory reserve is often inadequate to withstand the stresses brought on during anesthesia and surgery. A thorough clinical assessment and objective evaluation of pulmonary function and gas exchange can help identify which children are at particular risk for poor postoperative outcomes and thus merit preoperative interventions. These may include initiation and optimization of non-invasive ventilation and mechanical insufflation-exsufflation. Furthermore, such an evaluation will help identify children who may require a post-operative extubation plan tailored to neuromuscular diseases. Such strategies may include avoidance of pre-extubation lung decruitment by precluding continuous positive airway pressure trials, aggressively weaning to room air and extubating directly to non-invasive ventilation with a high inspiratory to expiratory pressure differential of at least 10 cm H20. Children with cerebral palsy and other neurodegenerative or neurodevelopmental disorders are a more heterogenous group of children who may share some operative risk factors with children with neuromuscular disease; they may also be at risk of sleep disordered breathing, may also require non-invasive ventilation or mechanical insufflation-exsufflation and may have associated chronic lung disease from aspirations that may require peri-operative treatment.
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