Hello. My project is titled Protocol-Driven Early Extubation in Patients with Flaccid Neuromuscular Scoliosis and Pre-Existing Lung Disease. Introduction. Neuromuscular scoliosis refers to the presence of a spinal deformity due to an underlying neurologic disorder. This may be due to spastic conditions such as cerebral palsy or flaccid conditions. Muscular dystrophy and spinal muscular atrophy are the most common causes of flaccid neuromuscular scoliosis. Bracing has limited indications in these conditions. Applying the brace to the child results in worsening of pre-existing lung disease and therefore progressive curves typically require surgery. These pre- and postoperative radiographs show a patient with muscular dystrophy with a large thoracic and lumbar scoliosis that was ultimately treated with T2-S1 posterior spinal fusion and spinal instrumentation along with pelvic instrumentation to give an example of the types of large surgeries that are needed in patients with these conditions. At our institution, all patients with flaccid neuromuscular scoliosis undergoing either posterior spinal fusion or a growing amount of instrumentation are enrolled in our extubation protocol. This is a multidisciplinary approach including involving the departments of anesthesiology, orthopedic surgery, pulmonary medicine, and pediatric intensive care. Patients remain intubated after treatment in the OR and are brought to the ICU where they are liberated directly to BiPAP at 12 over 6 centimeters of water. We sought to determine if this protocol resulted in improvements in care. We performed a retrospective review with IRB approval and patients with muscular dystrophy and spinal muscular atrophy were included. Baseline demographics, intraoperative findings, and postoperative outcomes were recorded. Comparisons were then made between children with muscular dystrophy and those with spinal muscular atrophy. A multivariate linear regression model was used to identify independent predictors of hospital length of stay. Results, 24 patients met inclusion criteria, 11 with muscular dystrophy, and 13 with spinal muscular atrophy. Muscular restrictive lung disease was present at 75%, and nocturnal BiPAP was used in the home at 68%. The average number of instrumented levels was 17, and there were three respiratory complications. One patient was reintubated. In our comparative study, patients with SMA were younger, lighter, and more likely to use nocturnal BiPAP in the home. Blood loss was higher in patients with muscular dystrophy, and transfusions were more common. Main comp correction did not differ between the two groups. In our multivariate model, the only predictor of overall length of stay was ICU length of stay. Discussion. Prior studies have shown higher rates of respiratory complications when patients are left intubated after surgery. Immediate extubation appears to be safe in patients with flaccid neuromuscular scoliosis when reviewing our data. There are only three complications and only one reintubation. Limitations of our study include retrospective nature with small cohorts, historical controls, and a single center study. However, despite these limitations, we think that our data shows that immediate extubation is safe and is likely the preferred treatment modality in these children. Thank you.

early extubation

flaccid neuromuscular scoliosis

pre-existing lung disease

multidisciplinary approach

BiPAP