| Consider extubating patients with DMD who have a forced vital capacity (FVC) <50% of predicted, and especially those with FVC <30% of predicted, directly to noninvasive positive pressure ventilation (NPPV) |
| • Consider delaying extubation until respiratory secretions are well-controlled and oxyhemoglobin saturation measured by pulse oximetry (SpO2) is normal or baseline in room air; continuous use of NPPV can then be weaned as tolerated |
| • When applicable, try to utilize the patient's home interface after extubation |
| Use supplemental oxygen therapy cautiously |
| • Monitor SpO2 continuously after general anesthesia or procedural sedation |
| • Whenever possible, monitor blood or end-tidal carbon dioxide levels |
| • Assess if hypoxemia is due to hypoventilation, atelectasis, or airway secretions, and treat appropriately |
| Use manually assisted cough and postoperatively in patients with DMD who have impaired cough, defined in adults as peak cough flow (PCF) <270 L/min or maximum expiratory pressure (MEP) <60 cmH2O |
| 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 gastrointestinal (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 to 48 hours postoperatively |
