Perioperative evaluation and treatment strategy for severe scoliosis with respiratory failure / 中华骨科杂志

ABSTRACT

Objective To investigate the preoperative evaluation of pulmonary function and protocol for scoliotic patients with respiratory failure. Methods From September 2000 to June 2008, sixteen patients suffered from respiratory failure were recruited into this study. There were two males and three females who were diagnosed as idiopathic scoliosis with a mean age of 13.5 years (range, 10-16 years). The other eleven patients were diagnosed as congenital scoliosis, including five males and six females with a mean age of 12.4 years (range, 10-14 years). The mean preoperative Cobb angle was 126.6°±15.5° with a mean height of 137.6 cm (range, 120-160 cm) and a mean weight of 32.5 kg (range, 18-40 kg). Decision was made depending on the severity of pulmonary impairment and spinal deformity. Preoperative treatment included respiratory training, noninvasive positive pressure ventilation therapy and halo-gravity traction. Results All patients received corrective surgery; ten patients were extubated tracheal tubes successfully 1 hour after surgery and six patients had to stay in intensive care unit (ICU) for 24 hours. Pulmonaryedema occurred in two cases and pneumonia in one case. The Cobb angle had improved to 72.0°±13.2° after surgery with a correction rate of 43%. All patients recovered well after surgery with no major cardiac or pulmonary complications.Conclusion Patients with preexisting respiratory failure can tolerate deformity correction operation with few complications after receiving a set of preoperative respiratory training modalities.