Bach John R, Sabharwal Sanjeev
University Hospital-UMDNJ, Newark, NJ, USA.
J Spinal Disord Tech. 2005 Dec;18(6):527-30. doi: 10.1097/01.bsd.0000154457.62714.4b.
There is little awareness among surgeons of the potential for noninvasive mechanical ventilation as an alternative to prolonged endotracheal intubation or tracheostomy for patients with neuromuscular scoliosis and ventilatory failure. These methods have not been reported for the perioperative management of scoliosis correction in patients with an inability to sustain their alveolar ventilation.
Five children with flaccid scoliosis secondary to muscular dystrophy or spinal muscular atrophy who had very high pulmonary risk were preoperatively trained in the use of noninvasive intermittent positive-pressure ventilation (IPPV) and mechanically assisted coughing prior to spinal fusion.
All patients were extubated by the third postoperative day to noninvasive IPPV despite continuous ventilator dependence. No patient developed any postoperative pulmonary complications or required a tracheotomy.
It is critical for the orthopedic surgeon to be aware of these noninvasive options to tracheotomy to decrease the tendency to avoid surgery for these otherwise high-risk surgical patients.
对于神经肌肉性脊柱侧弯和呼吸衰竭患者，外科医生很少意识到无创机械通气有可能替代长时间气管插管或气管切开术。对于无法维持肺泡通气的脊柱侧弯矫正患者围手术期管理，这些方法尚未见报道。
五名因肌肉萎缩症或脊髓性肌萎缩继发弛缓性脊柱侧弯且肺部风险极高的儿童，在脊柱融合术前接受了无创间歇性正压通气（IPPV）和机械辅助咳嗽的术前培训。
尽管患者持续依赖呼吸机，但所有患者在术后第三天均拔除气管插管，改为无创IPPV。没有患者出现任何术后肺部并发症或需要气管切开术。
骨科医生了解这些替代气管切开术的无创选择至关重要，以减少对这些原本高风险手术患者避免手术的倾向。
