Intensive Care Unit Monitoring Post-Tonsillectomy in Children with Obstructive Sleep Apnea

ObjectiveThere is a lack of consensus regarding postoperative care for pediatric patients with obstructive sleep apnea (OSA) following adenotonsillectomy. At our institution, all patients with severe OSA are routinely admitted to the pediatric intensive care unit (PICU), raising concerns about the optimal use of health care resources. The objective of this study was to identify the risk factors necessitating PICU admission for pediatric patients who underwent adenotonsillectomy for OSA.MethodsAn 8 year retrospective cohort study was conducted at a tertiary care pediatric hospital among consecutive patients with confirmed OSA undergoing adenotonsillectomy. All patients for whom a preoperative PICU request was made were included. A patient requiring PICU-level care was defined as needing respiratory support, such as intubation, positive pressure ventilation, or high-flow nasal cannula.ResultsA total of 112 medical charts were included in the analysis. Only 13 patients (11.6%) had respiratory complications requiring PICU-level care. No preoperative or intraoperative variables were predictive of need for PICU. Early-postoperative need for supplemental oxygenation (P = .002, OR = 6.7) and respiratory retraction (P < .000, OR = 27.4) were significant predictors of PICU-level airway escalation. Nearly all patients (11/13) requiring escalated airway measures were identified in the first 4 hours postoperatively.ConclusionA small subset of subjects with OSA required PICU-level care after adenotonsillectomy. Our data suggest that pediatric patients with OSA undergoing adenotonsillectomy may be safely monitored outside of an ICU setting for an extended period before determining eventual care setting.