Postoperative admission to paediatric intensive care after tonsillectomy

Area of Science:

• Pediatric critical care medicine
• Otolaryngology
• Anesthesiology

Background:

• Tonsillectomy and adenotonsillectomy are common pediatric procedures.
• Postoperative respiratory complications can necessitate intensive care unit admission.
• Understanding predictors for intensive care unit admission is crucial for resource allocation.

Purpose of the Study:

• To review interventions for children admitted to the pediatric intensive care unit (PICU) after tonsillectomy or adenotonsillectomy.
• To identify factors influencing the need for intensive care management in this population.

Main Methods:

• Retrospective chart review of 103 children admitted to the PICU over a 10-year period (April 2007-March 2017).
• Analysis of respiratory support therapies and airway interventions administered in the PICU.
• Review of patient demographics, comorbidities, and procedure indications.

Main Results:

• 103 children were admitted to the PICU post-tonsillectomy/adenotonsillectomy, with sleep-disordered breathing as a primary indication.
• 53 children had comorbidities; 31 used continuous positive airway pressure (CPAP); 5 had tracheostomies.
• 40 children did not require high-level care; 10 unplanned admissions had interventions initiated pre-PICU without escalation.

Conclusions:

• Children with an uneventful post-anesthetic care unit (PACU) recovery may not require PICU admission.
• High-flow nasal oxygen (HFNO) recipients could potentially be managed on the ward with adequate support.
• PACU care level can predict the PICU care intensity required in the immediate postoperative period.