Severe restrictive lung disease and vertebral surgery in a pediatric population

The aim of this study is to describe the outcome of surgical treatment for pediatric patients with forced vital capacity (FVC) <40% and severe vertebral deformity. Few studies have examined surgical treatment in these patients, who are considered to be at a high risk because of their pulmonary disease, and in whom preoperative tracheostomy is sometimes recommended. Inclusion criteria include FVC <40%, age <19 years and diagnosis of scoliosis. The retrospective study of 24 patients with severe restrictive lung disease, who underwent spinal surgery. Variables studied were age and gender, pre- and postoperative spirometry (FVC, FEV1, FEV1/FVC), preoperative, postoperative and late use of non-invasive ventilation (BiPAP) or mechanical ventilation, associated multidisciplinary treatment, type and location of the curve, pre- and postoperative curve values, type of vertebral fusion, intra- and postoperative complications, duration of intensive care unit (ICU) stay and length of postoperative hospitalization. Mean age was 13 years (9–19) of which 13 were males and 11 females. Mean follow-up was 32 months (24–45). The etiology was neuromuscular in 17 patients and other etiologies in 7 patients. Mean preoperative FVC was 26% (13–39%). Eight patients had preoperative home BiPAP, 15 preoperative in-hospital BiPAP, and 2 preoperative mechanical ventilation. Nine patients had preoperative nutritional support. Preoperative curve value of the deformity was 88° (40°–129°). Nineteen patients with posterior fusion alone and 5 with anterior and posterior fusion were found. Mean duration of ICU stay was 5 days (1–21). Total postoperative hospital stay was 17 days (7–33). Ventilatory support in the immediate postoperative includes 16 patients requiring BiPAP and 2 volumetric ventilation. None of the patients required a tracheostomy. The intraoperative complications include one death due to acute heart failure; immediate postoperative, four respiratory failures (2 required ICU readmission) and one respiratory infection; and other minor complications occurred in six patients. Overall, 58% of patients had complications. Percentage of angle correction was 56%. After a follow-up of 30 months, FVC was 29% (13–50%). In conclusion, corrective scoliosis surgery in pediatric patients with severe restrictive lung disease is well tolerated, but the management of this population requires extensive experience with the vertebral surgery involved, and a multidisciplinary approach that includes pulmonologists, nutritionists and anesthesiologists. Currently, there is no indication for routine preoperative tracheostomy

Meditative Movement Therapies and Health-Related Quality-of-Life in Adults: A Systematic Review of Meta-Analyses

Poor health-related quality-of-life (HRQOL) is a significant public health issue while the use of meditative movement therapies has been increasing. The purpose of this investigation was to carry out a systematic review of previous meta-analyses that examined the effects of meditative movement therapies (yoga, tai chi and qigong) on HRQOL in adults. Previous meta-analyses of randomized controlled trials published up through February, 2014 were included by searching nine electronic databases and cross-referencing. Dual-selection and data abstraction occurred. The Assessment of Multiple Systematic Reviews Instrument (AMSTAR) was used to assess methodological quality. Standardized mean differences that were pooled using random-effects models were included. In addition, 95% prediction intervals were calculated as well as the number needed-to-treat and percentile improvements. Of the 510 citations screened, 10 meta-analyses representing a median of 3 standardized mean differences in 82 to 528 participants (median = 270) with breast cancer, schizophrenia, low back pain, heart failure and diabetes, were included. Median methodological quality was 70%. Median length, frequency and duration of the meditative movement therapies were 12 weeks, 3 times per week, for 71 minutes per session. The majority of results (78.9%) favored statistically significant improvements (non-overlapping 95% confidence intervals) in HRQOL, with standardized mean differences ranging from 0.18 to 2.28. More than half of the results yielded statistically significant heterogeneity (Q ≤ 0.10) and large or very large inconsistency (I2 ≥ 50%). All 95% prediction intervals included zero. The number-needed-to-treat ranged from 2 to 10 while percentile improvements ranged from 9.9 to 48.9. The results of this study suggest that meditative movement therapies may improve HRQOL in adults with selected conditions. However, a need exists for a large, more inclusive meta-analysis (PROSPERO Registration #CRD42014014576)