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Evaluating pediatric intensive care unit utilization after tonsillectomy
Nathan D Vandjelovic1, Jenna W Briddell1, Meghan M Crippen2
1Division of Pediatric Otolaryngology, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE, USA; Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Insights
Children needing pediatric intensive care unit (PICU) intervention after adenotonsillectomy may be predicted by home positive airway pressure (PAP) use and low oxygen levels during sleep studies. Neuromuscular disorders also increase risk.
Area of Science:
- Pediatric critical care medicine
- Otolaryngology
- Sleep medicine
Background:
- Adenotonsillectomy is a common procedure in children.
- Some children require intensive care post-operatively, necessitating identification of at-risk individuals.
- Understanding predictors of pediatric intensive care unit (PICU) intervention is crucial for resource allocation and patient safety.
Purpose of the Study:
- To identify risk factors for PICU level intervention in pediatric patients following adenotonsillectomy.
- To compare characteristics of patients who did and did not require PICU intervention.
Main Methods:
- Retrospective cross-sectional study at a tertiary children's hospital.
- Analyzed data from 94 patients admitted to the PICU post-adenotonsillectomy.
- Compared demographics, polysomnography (PSG) data, comorbidities, and home positive airway pressure (PAP) use between patients who did and did not require PICU intervention.
Main Results:
- 26.5% of patients required PICU intervention, most commonly positive airway pressure (PAP).
- Preoperative home PAP use and an oxygen saturation nadir <80% on PSG were independent predictors of PICU intervention.
- Neuromuscular disorder was significantly associated with PICU intervention.
Conclusions:
- Home PAP use, neuromuscular disorder, and a preoperative oxygen nadir <80% on PSG are associated with PICU intervention after adenotonsillectomy.
- These factors can help identify children at higher risk for intensive care admission.
- Further research may focus on proactive management for these high-risk pediatric patients.
Objectives:
To identify patients at risk for a pediatric intensive care unit (PICU) level intervention after adenotonsillectomy.
Study Design:
Retrospective cross-sectional study.
Setting:
Tertiary Children's Hospital.
Subjects And Methods:
Ninety-four patients who were admitted to the PICU after adenotonsillectomy were included. The need for PICU level intervention, defined as high flow oxygen by nasal cannula, positive airway pressure (PAP), heliox, and intubation, was documented. The age, gender, BMI percentile, polysomnography (PSG) data, home PAP use, and accompanying comorbidities of patients who required a PICU level intervention were compared to those who did not.
Results:
Of the 94 patients admitted post-adenotonsillectomy to the PICU, most had at least one comorbidity, with obesity being the most common. PICU admission was unplanned in 29 (30.9%) patients. Postoperatively, 25 (26.5%) patients required a PICU level intervention, with PAP being the most common intervention. On chi-square analysis, there was no significant difference in the age, BMI percentile, or PSG parameters of children who required PICU intervention. Significantly more children who used preoperative PAP were started on PAP in PICU (p = 0.018). Only the comorbidity of neuromuscular disorder was associated with PICU intervention (p = 0.04). Using binary logistic regression, the use of home PAP and an oxygen nadir <80% on preoperative PSG were found to be independent predictors of PICU intervention (p = 0.04 and 0.025, respectively).
Conclusion:
Home PAP use, the presence of a neuromuscular disorder, and an oxygen nadir <80% on preoperative PSG is related to a PICU level intervention.
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