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Published on: January 17, 2011
Disposition to pediatric intensive care unit post supraglottoplasty repair: a systematic review
Esther ShinHyun Kang1,2, Sena Turkdogan1,3, Jeffrey C Yeung4,5,6
1Faculty of Medicine, McGill University, Montreal, Canada.
Insights
Routine pediatric intensive care unit (PICU) admission after supraglottoplasty may be unnecessary for many patients. Careful patient selection can help avoid unnecessary PICU admissions, reserving resources for those truly needing intensive care.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Critical Care Medicine
- Health Services Research
Background:
- Supraglottoplasty patients are often routinely admitted to the pediatric intensive care unit (PICU) due to rare airway compromise risks.
- This practice consumes intensivist resources, prompting a review of admission necessity.
Purpose of the Study:
- To determine the rate of PICU-level respiratory support needed post-supraglottoplasty.
- To identify risk factors for PICU admission to optimize resource allocation.
Main Methods:
- Systematic review of 3 databases (CINHAL, Medline, Embase) for pediatric supraglottoplasty studies.
- Inclusion criteria: pediatric patients requiring PICU admission or respiratory support.
- Meta-analysis of pooled proportions and risk factor assessment.
Main Results:
- Nine studies and 922 patients were included.
- 19% of supraglottoplasty patients required PICU admission.
- Risk factors for PICU admission included: neurological disease, low perioperative oxygen saturation, prolonged surgery, and age under 2 months.
Conclusions:
- Most supraglottoplasty patients do not require significant postoperative respiratory support.
- Routine PICU admission may be avoidable with careful patient selection.
- Further research is needed to define ideal PICU admission criteria.
Background:
Patients undergoing supraglottoplasty are often routinely admitted post-operatively to the pediatric intensive care unit (PICU) due to rare but potentially fatal complications such as airway compromise. A systematic review was performed to determine the rate of post-operative PICU-level respiratory support required by pediatric patients following supraglottoplasty, to identify risk factors for patients who may benefit from post-operative PICU admission and limit unnecessary use of intensivist resources.
Review Methods:
Key search terms 'supraglottoplasty' OR 'supraglottoplasties' were queried on three databases: CINHAL, Medline and Embase. Inclusion criteria were pediatric patients under 18 years of age who underwent a supraglottoplasty procedure with either an admission to PICU or requirement for PICU-level respiratory support. Risk of bias was assessed by two independent reviewers using QUADAS-2. Findings were critically appraised by three independent reviewers and pooled proportions of criteria meeting PICU admission were calculated for meta-analysis.
Results:
Nine studies met inclusion criteria, totaling 922 patients. Age at time of surgery ranged from 19 days to 15.7 years with mean age of 5.65 months. A weighted pooled estimate suggested that 19% (95% CI 14-24%) of patients who underwent supraglottoplasty required PICU-admission. The included studies revealed several patient and surgical factors have been linked to postoperative respiratory issues requiring PICU admission, including: neurological disease, perioperative oxygen saturation < 95%, prolonged surgical time and age < 2 months.
Conclusions:
This study found that the majority of supraglottoplasty patients do not require significant postoperative respiratory support and suggests that routine PICU admission of these patients may be avoided by careful patient selection. Given the wide heterogeneity of outcome measures, further studies are needed to determine the ideal PICU admission criteria following supraglottoplasty.
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