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

• DOI: 10.1111/aas.13844
• Publication Date: 2021-05-09T06:24:52Z
• Authors: Fabrizio Racca; Yaroslava Longhitano; Andrea Wolfler; Fabio Carfagna; Claudia Grattarola; Paola Serio; Fabio Sbaraglia; Angela Amigoni; Fabio Savron; Fabio Caramelli; Luigi Montagnini; Marinella Astuto; Elisa Gallo; Christian Zanza; Rosanna Vaschetto; Giorgio Conti
• Keywords: mechanical cough device; non-invasive ventilation; postoperative respiratory complications; noninvasive ventilation; 610; neuromuscular diseases; neuromuscular disease; anaesthesia; Neuromuscular Diseases; Anesthesia, General; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Italy; Humans; Prospective Studies; Child; Respiratory Insufficiency

BackgroundChildren with neuromuscular diseases (NMDs) often display respiratory muscle weakness which increases the risk of postoperative pulmonary complications (PPCs) after general anaesthesia. Non‐invasive ventilation (NIV) associated with mechanical insufflation–exsufflation (MI‐E) can reduce the incidence and severity of PPCs. The aim of this study was to report our experience with a shared perioperative protocol that consists in using NIV combined with MI‐E to improve the postoperative outcome of NMD children (IT‐NEUMA‐Ped).MethodWe conducted a multicentre, observational study on 167 consecutive paediatric patients with NMDs undergoing anaesthesia from December 2015 to December 2018 in a network of 13 Italian hospitals.ResultsWe found that 89% of the 167 children (mean age 8 years old) were at high risk of PPCs, due to the presence of at least one respiratory risk factor. In particular, 51% of them had preoperative ventilatory support dependence. Only 14 (8%) patients developed PPCs, and only two patients needed tracheostomy. Average hospital length of stay (LOS) was 6 (2‐14) days. The study population was stratified according to preoperative respiratory devices dependency and invasiveness of the procedure. Patients with preoperative ventilatory support dependence showed significantly higher intensive care unit (ICU) admission rate and longer hospital LOS.ConclusionDisease severity seems to be more related to the outcome of this population than invasiveness of procedures. NIV combined with MI‐E can help in preventing and resolve PPCs.