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The safety of respiratory positive pressure support immediately following pediatric tonsillectomy

Inbal Hazkani1, Tey Ching Siong2, Robert Hill3

  • 1Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

International Journal of Pediatric Otorhinolaryngology
|March 1, 2023
PubMed

Insights

Positive pressure respiratory support (PPS) is generally safe after tonsillectomy for pediatric obstructive sleep apnea (OSA). New-onset PPS use was linked to higher complication risks, indicating a more severe post-surgical condition.

Area of Science:

  • Pediatric critical care medicine
  • Otolaryngology
  • Sleep medicine

Background:

  • Adenotonsillectomy is the primary treatment for pediatric obstructive sleep apnea (OSA).
  • Postoperative hypoxia can complicate recovery, potentially requiring intervention.
  • The safety of positive pressure respiratory support (PPS) after tonsillectomy is not well-established.

Purpose of the Study:

  • To evaluate the incidence of complications associated with immediate postoperative PPS use.
  • To identify risk factors for complications in patients receiving PPS after tonsillectomy.

Main Methods:

  • Retrospective cohort study.
  • Inclusion of patients undergoing tonsillectomy and admitted to a pediatric intensive care unit (2015-2020).
  • Comparison of outcomes between patients receiving PPS and those not receiving PPS.

Main Results:

  • 101 of 780 patients received immediate postoperative PPS.
  • One patient in the PPS group experienced pneumomediastinum and pneumothorax.
  • Life-threatening complications occurred in 12% of the PPS group versus 2% of the non-PPS group; these were primarily in patients not using PPS at baseline.
  • Body mass index, surgical technique, and PPS use were associated with increased odds of life-threatening complications.

Conclusions:

  • Positive pressure respiratory support (PPS) appears generally safe for use after tonsillectomy.
  • New-onset PPS is associated with increased odds of severe complications, suggesting it may be initiated in more clinically unstable patients.
Abstract

Keywords:
Obstructive sleep apneaPositive pressure supportPost tonsillectomy bleedingTonsillectomy

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