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

Intraoperative Considerations

OR Team

Anesthesia Providers

Admit Postop

All Patients: Standard Postoperative Management
Pain Management
Tubes and Drains
Nutrition
Infectious Disease
Consultations

Moderate-Risk – Consider PICU Admission
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
PICU Transfer Out Criteria
Extubated
Adequate analgesia
Arterial line removed
Hemodynamically stable
ICU Management
Hemodynamic
Respiratory
Activity
Laboratory testing
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
Inpatient Management
Hemodynamic
Respiratory
Activity
Laboratory testing
Transfer to Surgical/Specialty
Pulmonary/PCU/4E/4S as appropriate
Inpatient Goals
Convert to PO/
enteral analgesia
Pulmonary toileting
Advance mobility
Inpatient Management
Hemodynamic
Respiratory
Activity
Laboratory testing
Posted: May 2016
Revised: October 2023
Editors: Clinical Pathways Team