What are the American College of Chest Physicians (ACCP) guidelines for postoperative 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

Postoperative measures include the following:

  • Consider extubation directly to NPPV in DMD patients with FVC <50% of predicted, and especially those with FVC <30% of predicted
  • Consider delaying extubation until respiratory secretions are well controlled and SpO 2 is normal or baseline in room air; continuous use of NPPV can then be weaned as tolerated
  • Use supplemental oxygen therapy cautiously; monitor Spo 2 continuously
  • Whenever possible, monitor blood or end-tidal carbon dioxide levels
  • Assess whether hypoxemia is due to hypoventilation, atelectasis, or airway secretions and treat appropriately
  • Use manually assisted cough and MI-E postoperatively for patients with impaired cough (PCF 2</sub>O in adults)
  • Optimize postoperative pain control in patients with DMD; if sedation and/or hypoventilation occurs, delay endotracheal extubation for 24 to 48 hours or use NPPV
  • Obtain a cardiology consultation and closely monitor cardiac and fluid status postoperatively
  • Initiate bowel regimens to avoid and treat constipation and consider prokinetic GI medications
  • Consider gastric decompression with a nasogastric tube in patients with GI dysmotility
  • Start parenteral nutrition or enteral feeding via a small-diameter tube if oral feeding is delayed for >24-48 hours postoperatively

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