Perioperative management of children with neuromuscular disorders based on a common protocol: A prospective, national study in Italy

Fabrizio Racca, Yaroslava Longhitano, Andrea Wolfler, Fabio Carfagna, Claudia Grattarola, Paola Serio, Fabio Sbaraglia, Angela Amigoni, Fabio Savron, Fabio Caramelli, Luigi Montagnini, Marinella Astuto, Elisa Gallo, Christian Zanza, Rosanna Vaschetto, Giorgio Conti

Risultato della ricerca: Contributo in rivistaArticolo in rivista


Background: Children with neuromuscular diseases (NMDs) often display respiratory muscle weakness which increases the risk of postoperative pulmonary complications (PPCs) after general anaesthesia. Non-invasive ventilation (NIV) associated with mechanical insufflation–exsufflation (MI-E) can reduce the incidence and severity of PPCs. The aim of this study was to report our experience with a shared perioperative protocol that consists in using NIV combined with MI-E to improve the postoperative outcome of NMD children (IT-NEUMA-Ped). Method: We conducted a multicentre, observational study on 167 consecutive paediatric patients with NMDs undergoing anaesthesia from December 2015 to December 2018 in a network of 13 Italian hospitals. Results: We found that 89% of the 167 children (mean age 8 years old) were at high risk of PPCs, due to the presence of at least one respiratory risk factor. In particular, 51% of them had preoperative ventilatory support dependence. Only 14 (8%) patients developed PPCs, and only two patients needed tracheostomy. Average hospital length of stay (LOS) was 6 (2-14) days. The study population was stratified according to preoperative respiratory devices dependency and invasiveness of the procedure. Patients with preoperative ventilatory support dependence showed significantly higher intensive care unit (ICU) admission rate and longer hospital LOS. Conclusion: Disease severity seems to be more related to the outcome of this population than invasiveness of procedures. NIV combined with MI-E can help in preventing and resolve PPCs.
Lingua originaleEnglish
pagine (da-a)1195-1204
Numero di pagine10
RivistaActa Anaesthesiologica Scandinavica
Stato di pubblicazionePubblicato - 2021


  • anaesthesia
  • mechanical cough device
  • neuromuscular diseases
  • non-invasive ventilation
  • postoperative respiratory complications


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