ICU, Inpatient and Outpatient Specialty Care Clinical Pathway for Children with Neuromuscular Scoliosis Post-Op Management of Spinal Fusion

  • Related Order Set
  • Neuromuscular Scoliosis Postoperative
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
Admit Postop
All Patients: Standard Postoperative Management
Pain Management
Tubes & Drains
Nutrition
Infectious Disease
Consultations
Moderate – Consider ICU 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: April 2018 (Reviewed), March 2020, April 2020
Authors: K. Baldwin, E. Stegonshek, T. Muhly, K. Ryan, D. Singh, H. Wolfe, P. Konen