Inpatient and PICU Clinical Pathway for Management of Children with Neuromuscular Scoliosis Undergoing Spine Fusion
Complications
- ICU
- Respiratory insufficiency
- Blood loss/coagulopathy
- Lactic acidosis
- SIRS response
- Neurogenic shock
- Ileus
- Inpatient
- Increased respiratory requirements
- Incisional drainage
- Ileus
- Persistent fever > 72 hours
- Urinary retention
- Seroma
- Orthopedic Preoperative Evaluation
- Guidance for Determining Risk
1 Day Before Surgery
Anesthesia Preoperative Preparation
Anesthesia Preoperative Preparation
Admit Postop
All Patients: Standard Postoperative Management
Pain Management
Tubes and Drains
Nutrition
Infectious Disease
Consultations
Moderate-Risk – Consider PICU Admission
High-Risk – PICU
High-Risk – PICU
- Patient characteristics:
- Preop: Baseline trach/vent, CPAP/BiPAP, cardiac dysfunction
- Intraop: Spinal shock, blood loss > 1 blood volume, ongoing hypotension
ICU Goals
IV analgesia
CV stability
Pulmonary toilet
Advance mobility
IV analgesia
CV stability
Pulmonary toilet
Advance mobility
PICU Transfer Out Criteria
Extubated
Adequate analgesia
Arterial line removed
Hemodynamically stable
Extubated
Adequate analgesia
Arterial line removed
Hemodynamically stable
Low-Risk – 4E/4S Surgical Unit or 8 South
- Patient characteristics:
- Preop: Ambulatory, minimal pulmonary disease
- Intraop: Curve < 80 degrees
Inpatient Goals
Convert to PO/
enteral analgesia
Pulmonary toileting
Advance mobility
Convert to PO/
enteral analgesia
Pulmonary toileting
Advance mobility
Transfer to Surgical/Specialty
Pulmonary/PCU/4E/4S as appropriate
Pulmonary/PCU/4E/4S as appropriate
Inpatient Goals
Convert to PO/
enteral analgesia
Pulmonary toileting
Advance mobility
Convert to PO/
enteral analgesia
Pulmonary toileting
Advance mobility
Evidence
- Patient Population Information
- Releasing the Tether: Weight Normalization Following Corrective Spinal Fusion in Cerebral Palsy
- Surgeon and Caregiver Agreement on the Goals and Indications for Scoliosis Surgery in Children with Cerebral Palsy
- Do All Patients With Cerebral Palsy Require Postoperative Intensive Care Admission After Spinal Fusion?
- Improving Health-related Quality of Life for Patients With Nonambulatory Cerebral Palsy: Who Stands to Gain From Scoliosis Surgery?