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Postoperative bilevel positive airway pressure ventilation after tonsillectomy and adenoidectomy in children--a
O Friedman1, A Chidekel, S T Lawless
1Thomas Jefferson University, Philadelphia, PA, USA.
Insights
Bilevel positive airway pressure (BiPAP) offers safe and effective respiratory support for children after adenotonsillectomy, especially those with pre-existing conditions, avoiding intubation risks.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Obstructive sleep apnea (OSA) in children often stems from tonsil and adenoid hypertrophy, with adenotonsillectomy as the primary treatment.
- Post-adenotonsillectomy respiratory distress may necessitate intubation and mechanical ventilation.
- Positive airway pressure (PAP) devices, including bilevel positive airway pressure (BiPAP), are emerging as alternatives for temporary airway support.
Purpose of the Study:
- To evaluate the safety and efficacy of BiPAP in pediatric patients undergoing adenotonsillectomy.
- To identify potential complications associated with BiPAP use in this specific patient population.
- To assess BiPAP as an alternative to mechanical ventilation for postoperative airway obstruction.
Main Methods:
- Retrospective review of pediatric intensive care unit admissions between January 1997 and July 1998.
- Identification of patients who underwent adenotonsillectomy and required postoperative BiPAP.
- Analysis of patient characteristics, including comorbidities and outcomes.
Main Results:
- Nine out of 1321 pediatric patients required postoperative BiPAP after adenotonsillectomy.
- Patients requiring BiPAP often had comorbidities such as obesity, neurological disorders, asthma, or prior sinus surgery.
- All nine patients tolerated BiPAP without reported complications, with two obese children discharged on home BiPAP.
Conclusions:
- BiPAP appears to be a safe and effective respiratory support method for adenotonsillectomy patients with pre-existing conditions.
- Utilizing BiPAP can help avoid the risks associated with intubation and mechanical ventilation in this cohort.
- This preliminary study suggests BiPAP is a viable option for managing postoperative airway obstruction in at-risk pediatric patients.
Abstract:
Obstructive sleep apnea (OSA) in children, characterized by hypoventilation secondary to upper airway obstruction, often results from tonsil and adenoid hypertrophy. Adenotonsillectomy is the standard therapy in this patient population. The immediate postoperative period is complicated occasionally by respiratory difficulties that may require intubation and mechanical ventilation. Recently, physicians have provided temporary airway support using continuous and bilevel positive airway pressure (BiPAP) devices. Reported complications of positive airway pressure devices include local abrasions to the nose and mouth; dryness of the nose, eyes, and mouth; sneezing; nasal drip, bleeds, and congestion; sinusitis; increased intraocular pressure; non-compliance; and pneumocephalus. Subcutaneous emphysema following facial trauma, dental extractions, adenotonsillectomy, and sinus surgery has been reported. There is also a hypothetically increased risk of subcutaneous emphysema following the use of positive airway pressure ventilation in the tonsillectomy patient. Between January 1997 and July 1998, 1321 patients underwent tonsillectomy and/or adenoidectomy at our institution. In reviewing the records of all pediatric intensive care unit admissions during that time period, we identified nine patients, of the 1321, who required BiPAP postoperatively. Of these, four children were obese, four had preexisting neurological disorders, and one underwent endoscopic sinus surgery and adenoidectomy. Three children were asthmatic, and three were less than 3 years of age. Two obese children were discharged with home BiPAP, one of whom had been on BiPAP prior to surgery. All patients tolerated BiPAP without complications. This preliminary report suggests that BiPAP is a safe and effective method of respiratory assistance in the adenotonsillectomy patient with preexisting conditions who is predisposed to postoperative airway obstruction. Furthermore, with BiPAP, the risks of intubation and ventilator dependence are avoided.
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