Non-invasive positive pressure ventilation to facilitate the post-operative respiratory outcome of spine surgery in neuromuscular children

Scoliosis surgery may be associated with a high morbidity and even mortality in children with non-idiopathic scoliosis. The aim of the study was to report our experience with a pre-operative training to non-invasive positive pressure ventilation (NPPV) and a mechanical insufflator-exsufflator (MI-E) device to improve the post-operative respiratory outcome of children scheduled for scoliosis surgery. Consecutive patients with non-idiopathic scoliosis undergoing posterior arthrodesis were trained to NPPV and MI-E before intervention. NPPV and MI-E were performed immediately after extubation. Length of intubation and intensive care unit (ICU) stay, duration of NPPV, and respiratory complications were assessed. Thirteen patients participated in the training (mean age 13.9 +/- A 2.6, mean vital capacity 52.3 +/- A 15.4 % predicted). The patients had severe respiratory muscle weakness with a mean sniff oesophageal pressure of 35.8 +/- A 14.2 cmH(2)O (50 % predicted) and a mean gastric pressure during a cough of 31.9 +/- A 7.8 cmH(2)O (30 % predicted). The mean length of intubation was 19.9 +/- A 12.3 h with a mean length of ICU stay of 2.5 +/- A 2.5 days. NPPV was used during a mean of 2.7 +/- A 1.9 days after surgery. No respiratory complication was observed. One patient died 3 months after surgery from multi-organ failure of non-respiratory origin. No respiratory complications were observed after scoliosis correction surgery in children with non-idiopathic scoliosis after pre-operative training and post-operative use of NPPV and MI-E, underlying the interest of this management in these high-risk patients.