What are the American College of Chest Physicians (ACCP) guidelines for preoperative respiratory support of patients with Duchenne muscular dystrophy (DMD)?

Updated: Aug 17, 2020
  • Author: Twee T Do, MD; Chief Editor: Jeffrey D Thomson, MD  more...
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Answer

Surgical precautions

In 2007 the American College of Chest Physicians (ACCP) published a consensus statement of recommendations for preoperative, intraoperative, and postoperative respiratory support for DMD patients undergoing procedures requiring anesthesia or sedation. [74]

Preoperative respiratory support

Anesthesiology and pulmonology consultations should be obtained, according to the ACCP. Pulmonary evaluation should include measurement of the following:

  • FVC
  • Maximum inspiratory pressure (MIP)
  • Maximum expiratory pressure (MEP)
  • Peak cough flow (PCF)
  • Oxyhemoglobin saturation by pulse oximetry (SpO 2) in room air; if <95%, measure the blood and/or end-tidal carbon dioxide level
  • Consider preoperative training in the use of noninvasive positive pressure ventilation (NPPV) for patients at increased risk of respiratory complications (FVC <50% of predicted) and especially for patients at high risk (FVC <30% of predicted)
  • Consider preoperative training in manual and mechanically assisted cough, emphasizing use of mechanical insufflation-exsufflation (MI-E) with a bronchial secretion clearance device for patients at high risk of ineffective cough (adults with PCF 2</sub>O)

Other preoperative measures should include the following:

  • Refer the patient to a cardiologist for clinical evaluation and optimization of cardiac therapies
  • Nutritional assessment and optimization of nutritional status is required
  • Consider strategies to manage dysphagia
  • Discuss the risks and benefits of general anesthesia or procedural sedation with the patient and guardians, and help them to decide on and implement their decisions regarding resuscitation parameters and, if applicable, advance directives

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