Learn. Share. Grow.

Title: VEPTR: Are We Reducing Respiratory Assistance Requirements?

Authors: Sarah B. Nossov, MD; Evan Curatolo, MD; Robert M. Campbell, MD; Oscar H. Mayer, MD; Sumeet Garg, MD; Patrick Cahill, MD; and On Behalf of the Children’s Spine Study Group

Journal: J PediatrOrthop. April 10, 2017 - Volume Publish A

Date: April 01, 2017

Excerpt: It’s important to note that the natural history of TIS is typically one of progressive dependence on respiratory support; it’s unclear what improvement is related to the VEPTR or other interventions such as pulmonary care (i.e. “cough assist”).

Keywords: VEPTR;Early-onset scoliosis; Thoracic Insufficiency Syndrome; Assisted Ventilation Rating

Summary:

What is the purpose of this study?

Some children with thorasic insuffiency syndrome (TIS) and early onset scoliosis(EOS) require external respiratory support. This often leads to the decision to implant of the VEPTR device early to improve lung volume and development. This study was done to see if children who had the VEPTR device implanted early would also see improvement in the need for respiratory assistance. External respiratory assistance is measured by an Assisted Ventilation Rating (AVR) method.

Results

The largest multicenter registry was analyzed and identified 377 patients with TIS requiring ventilator support and the VEPTR device implanted before age 10 years, who also had complete AVR data. Of those, 77 patients had abnormal initial AVRs. The 77 were then placed into three groups of AVR (No change, Positive change and Negative change) Patient follow up was a minimum of 2 years, the average being 5.6 years.

  • Of the 77 patients with an abnormal AVR 64% showed no changefrominitial to final assessment
  • Of the 77 patients with an abnormal AVR 25% showed improvement from initial to final assessment
  • Of the 77 patients with an abnormal AVR 12%declined from initial to final assessment.
  • - 46% were ventilator free at final assessment
  • A subset of patients was identified who improved a great deal, improving 3 AVR levels. Moving from full time ventilator dependence to part-time use.
  • 88% remained stable or improved at final assessment which on average was 5.6 yrs.
  • Patients with an improved AVR were younger and had smaller curves at VEPTR insertion.
  • Patients with an AVR that declined were older and had larger curves before VEPTR implant.

Discussion Points

Remaining stable or showing improved AVR can typically be regarded as an improvement in quality of life simply by not declining. For example, a change from full time ventilator dependence to part-timeis only measured by one level of AVR improvement, that change can be have a major impact on a family. Patients with an AVR that declined were older and had larger curves, these findings may support the role of early intervention in critical times of lung growth for patients with TIS who require ventilator assistance. It's important to note that the natural history of TIS is typically one of progressive dependence on respiratory support; it's unclear what improvement is related to the VEPTR or other interventions such as pulmonary care (i.e. "cough assist").