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Incidence and Risk Factors Associated with Respiratory Compromise in Planned PICU Admissions Following Tonsillectomy

Inbal Hazkani1,2, Eli Stein2, Tey Ching Siong3

  • 1Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.

The Annals of Otology, Rhinology, and Laryngology
|August 19, 2022
PubMed

Insights

Respiratory compromise occurred in 3.7% of pediatric patients after tonsillectomy or adenotonsillectomy requiring PICU admission. Pre-operative oxygen levels and enteral feeding dependence were linked to increased risk.

Area of Science:

  • Pediatric critical care medicine
  • Otolaryngology
  • Respiratory physiology

Background:

  • Tonsillectomy and adenotonsillectomy (T/AT) are common pediatric procedures.
  • Patients with obstructive sleep apnea often undergo T/AT and may have planned pediatric intensive care unit (PICU) admissions.
  • Respiratory compromise is a potential complication requiring intensive care.

Purpose of the Study:

  • To determine the incidence of respiratory compromise in children with planned PICU admissions post-T/AT.
  • To identify factors associated with respiratory compromise in this patient population.

Main Methods:

  • Retrospective cohort study of patients admitted to the PICU following T/AT between 2015 and 2020.
  • Data collected included demographics, comorbidities, operative details, and respiratory complications.
  • Multivariable regression analysis was used to identify associated factors.

Main Results:

  • 3.7% of 772 patients experienced respiratory compromise requiring PICU support.
  • Common comorbidities included neuromuscular disease, enteral feed dependence, and obesity.
  • Pre-operative oxygen nadir and enteral feed dependence were significant predictors of respiratory compromise.

Conclusions:

  • Respiratory compromise requiring PICU intervention occurs in a small percentage of pediatric patients post-T/AT.
  • Pre-operative oxygen saturation nadir and reliance on enteral feeds are key factors associated with increased risk.
  • These factors should be considered in post-operative care planning and disposition decisions.
Abstract

Keywords:
adenotonsillectomypositive airway respiratory supportre-intubationrespiratory compromise

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