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Critical care resources utilized in high-risk adenotonsillectomy patients
Jennifer M Lavin1,2, Craig Smith3,4, Zena Leah Harris3,4
1Division of Pediatric Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.
Insights
Most children undergoing adenotonsillectomy do not require intensive care, even those at high risk. Respiratory complications in pediatric intensive care unit (PICU) patients are often evident within two hours post-surgery.
Area of Science:
- Pediatric critical care medicine
- Otolaryngology
- Respiratory medicine
Background:
- Children at high risk for respiratory complications after adenotonsillectomy are frequently admitted to the pediatric intensive care unit (PICU).
- The actual utilization of critical care resources by these patients remains largely unquantified.
Purpose of the Study:
- To audit the intensive care needs of post-adenotonsillectomy patients admitted to the PICU.
- To identify factors associated with the utilization of critical care resources in this high-risk pediatric population.
Main Methods:
- A retrospective review of 110 patients admitted to a tertiary pediatric hospital's PICU after adenotonsillectomy between July 2013 and March 2017.
- Data collected included demographics, ICU admission indication, polysomnogram results, and comorbidities.
- ICU resource utilization was defined by specific criteria including oxygen requirements, desaturation events, and nursing intervention frequency.
Main Results:
- 18.2% of patients (20 out of 110) met the defined criteria for ICU resource utilization.
- The need for resources was often identified within 2 hours postoperatively (70% of resource-utilizing patients).
- Younger age, gastrostomy tube status, and neuromuscular disorders were associated with ICU resource utilization, while apnea hypopnea index and obesity were not.
Conclusions:
- The majority of high-risk adenotonsillectomy patients admitted to the PICU do not utilize critical care resources.
- Early identification of patients requiring critical care is possible within the first two hours post-surgery.
- This suggests that while perioperative risk is elevated, intensive resource utilization is not the norm for this cohort.
Objective:
Children at high risk for respiratory complication after adenotonsillectomy are often admitted to a pediatric intensive care unit (PICU) postoperatively. Although many patients receive care in such units, it is unknown how many utilize critical care resources.
Methods:
A review was conducted to audit intensive care needs of postadenotonsillectomy patients admitted to the PICU at a tertiary, academic, pediatric hospital between July 2013, and March 2017. Demographic information, ICU indication, polysomnogram results, and comorbidities were collected. Patients were defined as needing ICU resources based on supplemental oxygen requirements greater than 2 L between 2 to 24 hours postoperatively, more than two desaturation events in a 2-hour period, or more than hourly nursing intervention. Factors associated with utilization of ICU resources were assessed.
Results:
One hundred and ten patients were admitted to the PICU after adenotonsillectomy. Median age was 4.2 years, median body mass index was 90.8 percentile, and median apnea hypopnea index (AHI) was 34.3. Twenty patients (18.2%) utilized ICU resources by criteria defined. Of these patients, 14 were known to need such resources by 2 hours postoperatively (70%, negative predictive value 93.8%). Neither AHI nor obesity status was correlated with need for resources; however, resource need was associated with young age, gastrostomy tube status, and neuromuscular disorders (P = 0.048, P = 0.002 and 0.013, respectively).
Conclusion:
Most high-risk adenotonsillectomy patients do not utilize critical care resources despite their increased perioperative risk. Patients with respiratory complications are frequently identifiable within the first 2 hours of surgery.
Level Of Evidence:
4 Laryngoscope, 129:1229-1234, 2019.
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