Neuromuscular Scoliosis Spinal Fusion — Post Operative ICU Management — Clinical Pathway

Neuromuscular Scoliosis Spinal Fusion Clinical Pathway — ICU, Inpatient, Outpatient Specialty Care

Postoperative Intensive Care Management

The majority of patients will recover in the ICU for at least one night.

Clinical Area Goals Specifics
Hemodynamic
  • Stable
  • Remove CVL as early as appropriate
  • Arterial line in place
    • Maintain overnight and remove on POD #1 if appropriate
  • Maintain CVL
    • Monitor central venous pressure (CVP) for minimum 24 hours
  • Consult cardiology in any patient with cardiomyopathy and/or who received cardiac anesthesia
  • Monitor for:
    • Ongoing blood loss/coagulopathy (increased JP drain output or trending labs) lactic acidosis
    • SIRS response (hypotension, tachycardia, fever, low UOP < 1 ml/kg/hr)
      Neurogenic shock
Respiratory
  • Return to baseline respiratory status
  • Pulmonary toileting
  • If intubated, extubate as soon as clinically appropriate
  • Maintain HOB at 30°
  • Begin pulmonary toilet POD #0
    • IPV/cough assist, chest PT scheduled minimum q4 hours
  • Resume baseline respiratory regimen if appropriate
  • Hold Theravest x2 weeks for incisional healing
  • Consult pulmonary if followed at baseline
  • Monitor for:
    • Respiratory insufficiency
      • Consider inadequate pain control, pulmonary toilet, or activity (mobility, PT/OT, turning)
    • Hemothorax/pneumothorax
Activity/PT
  • Advance
  • All patients
    • Log roll q2 hours and PRN until patient can roll independently, if able
    • Start PT and OT daily
    • SCDs while in bed and asleep
    • Use thoracolumbar spinal orthosis (TLSO) brace only if ordered and if requested for patient comfort
  • See additional resources on
  • Consult PT if remain intubated and hemodynamically stable for progressive mobility on POD #1 if appropriate from participation standpoint
  • If extubated
    • POD #0: log roll q2 overnight and sit on edge of bed
    • POD #1: sit on edge of bed
    • Out of bed to chair TID, as tolerated
Laboratory
  • Monitor
  • Not required upon admission unless clinically indicated
  • If stable on POD #1, no additional labs required for POD #2