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Published on: January 29, 2011
Respiratory complications from nasal packing: systematic review
Brian Rotenberg1, Samantha Tam
1Department of Otolaryngology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON. Brian.Rotenberg@sjhc.london.on.ca
Summary
Patients undergoing posterior nasal packing face uncertain risks of respiratory complications. This review found limited high-quality evidence suggesting mild sleep apnea may occur, but not widespread severe events requiring monitored admission.
Area of Science:
- Otolaryngology
- Pulmonology
- Critical Care Medicine
Background:
- Posterior nasal packing is frequently used for epistaxis.
- Concerns exist regarding potential respiratory complications in patients with posterior nasal packing.
- The required level of vital sign monitoring for these patients remains unclear due to conflicting evidence.
Purpose of the Study:
- To systematically review existing literature on respiratory complications associated with nasal packing.
- To evaluate the evidence supporting the risk of adverse respiratory events after posterior nasal packing.
- To inform clinical practice regarding patient monitoring after nasal packing.
Main Methods:
- A systematic literature search was conducted on Medline and Embase before July 2009.
- Included original research and review articles focusing on nasal packing for epistaxis.
- Studies were assessed for quality using a modified Downs and Black scale; data on respiratory complications were extracted.
Main Results:
- 14 studies met inclusion criteria, including case series, cohort studies, and reviews.
- Limited high-quality literature exists on adverse respiratory events following posterior packing.
- Some studies suggest a potential for mild sleep apnea post-packing, but evidence is sparse.
Conclusions:
- Current literature on respiratory complications from posterior nasal packing is largely based on expert opinion and case series.
- There is insufficient evidence to mandate admission or intensive monitoring for all patients receiving posterior nasal packing.
- While mild sleep apnea may be a potential complication, the overall risk of severe respiratory events appears low.
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