Nanci Yuan, MD
Publication Details
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PreOperative Predictors of Prolonged Post-Operative Mechanical Ventilation in Children Following Scoliosis Repair
Pediatr. Pulmonol. 2005; (5): 414-419Objective. Scoliosis is associated with progressive restrictive lung disease and increased risk of pulmonary complications following surgical correction. Identification of higher risks for prolonged post-operative mechanical ventilation (MV) improves post-operative care. Our objective was to determine if pre-operative pulmonary function tests (PFT) predict prolonged post-operative MV (defined MV > 3 days). Methods. Reviewed/correlated pre-operative PFT (FEV1, VC, IC, MIP, TLC, and RV) and post-operative MV days in 125 patients who had scoliosis surgery (age 13.7 + 3.0 [SD] years) from January 1990 - July 2001. Patients: 71 male, 54 female. Scoliosis type: 13 congenital, 27 idiopathic, 57 neuromuscular, 23 syndrome/tumor, and 5 kyphoscoliosis. Results. Post-operative MV >3 days: 40 patients (32%). Independent factors likely to require post-operative MV >3 days: neuromuscular scoliosis (p <0.001) and FEV1 <40% pred. Most likely: neuromuscular scoliosis with pre-operative FEV1 < 40% pred (p < 0.01). Unlikely: idiopathic scoliosis (p < 0.002). VC <60% pred, IC <30 mL/kg, TLC <60% pred, MIP <60 cm H2O correlated with post-operative MV >3 days (p < 0.05). No association between RV and postoperative MV. Conclusion. FEV1 <40% pred, VC <60% pred, IC <30 mL/kg, TLC <60% pred, MIP <60 cm H2O, neuromuscular disease, each correlates with prolonged post-operative MV. Neuromuscular disease or a pre-operative FEV1 < 40% pred were more likely, and older children with neuromuscular disease and FEV1< 40% pred were most likely to require prolonged post-operative MV (p < 0.01). Clearly FEV1, and possibly VC, IC, TLC, and MIP, may increase prediction accuracy in predicting the need for prolonged post-operative MV.
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