Pre-operative respiratory optimisation before paediatric neuromuscular scoliosis surgery: a systematic review
In brief
Respiratory protocols supported early extubation in 308 children, but evidence remains weak
A review of 10 observational studies found that respiratory optimization, often including noninvasive ventilation and airway clearance, was feasible and linked to successful early extubation and few complications, even in children with severe lung restriction. But the studies were varied and lacked strong comparisons, leaving very low certainty about which strategies work best.
- Journal
- Spine deformity (Q2)
- Published
- 4 November 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Adham E M Mousa, Chinedu Egu, Ahmed Fadulelmola, Mohammed Shakil Patel
- PMID
- 42983177
- DOI
- 10.1007/s43390-026-01586-6
Why clinicians should know about it
- Picked for Spine Surgery (top studies of the week, 8 November 2026): Perioperative pulmonary optimization for pediatric neuromuscular scoliosis correction
Abstract
PURPOSE: Respiratory complications remain a major cause of perioperative morbidity following paediatric neuromuscular scoliosis (NMS) surgery. Although respiratory optimisation strategies are widely used, their effectiveness remains uncertain. This systematic review evaluated respiratory optimisation strategies and postoperative pulmonary outcomes in children undergoing NMS correction. METHODS: This systematic review followed PRISMA 2020 guidelines. PubMed/MEDLINE, Embase and CENTRAL were searched from inception to June 2026. Studies evaluating respiratory optimisation in paediatric NMS surgery were included. Two reviewers independently screened studies, extracted data and assessed methodological quality using Joanna Briggs Institute checklists. Certainty of evidence was assessed using GRADE. Findings were synthesised narratively owing to clinical and methodological heterogeneity. RESULTS: Ten observational studies involving 308 children were included. Interventions comprised non-invasive ventilation (NIV), mechanical insufflation-exsufflation, pulmonary rehabilitation, inspiratory muscle training, protocolised extubation and multidisciplinary perioperative pathways. NIV-based protocols reported successful early extubation and few respiratory complications, including amongst children with severe restrictive lung disease. Pulmonary rehabilitation and inspiratory muscle training were associated with improved pre-operative respiratory function, whilst multidisciplinary pathways reported favourable postoperative outcomes. Four studies had low and six had moderate methodological risk. However, the certainty of evidence was very low across principal respiratory outcomes, reflecting uncontrolled designs, heterogeneous interventions and imprecise comparative estimates. CONCLUSIONS: Structured respiratory optimisation appears feasible in children undergoing NMS correction, including those with substantial respiratory impairment. NIV and airway clearance are recurring components of reported pathways, but their comparative effectiveness remains uncertain. Prospective multicentre studies are needed to establish effective optimisation strategies and standardise perioperative respiratory care.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.