Blenke E J S M, Anderson A R, Raja Hemal, Bew S, Knight L C
Department of Otolaryngology-Head and Neck Surgery, The General Infirmary at Leeds, Leeds, UK.
J Laryngol Otol. 2008 Jan;122(1):42-5. doi: 10.1017/S0022215107007566. Epub 2007 Apr 3.
To identify regional surgical referral patterns for adenotonsillectomy in children with obstructive sleep apnoea to our tertiary centre with paediatric intensive care unit facilities and to establish guidelines for elective paediatric intensive care unit referral and admission.
Two methods were used. A questionnaire was sent to ENT consultants in five surrounding hospitals with no in-house paediatric intensive care facilities. The second was a prospective observational study undertaken in our tertiary centre for a sub-set of patients undergoing obstructive sleep apnoea adenotonsillectomy between January 2002 and February 2005. These children were considered high risk as judged clinically by an ENT surgeon. Most had obstructive sleep apnoea and a co-morbidity. Otherwise healthy children with simple obstructive sleep apnoea were excluded.
15 out of 20 consultants responded to the questionnaire. Four referred on the grounds of clinical history, five referred based on pulse oximetry, nine referred syndromal children and four did not refer electively. Of the 49 high risk patients operated on, only 12 required paediatric intensive care admission with no emergency paediatric intensive care admissions. No otherwise healthy children with uncomplicated obstructive sleep apnoea symptoms required paediatric intensive care admission during the study period.
There was no regional consensus regarding paediatric intensive care unit referral for obstructive sleep apnoea adenotonsillectomy. Clinical judgement without complex sleep studies by those experienced in this area was sufficient to detect complicated cases of obstructive sleep apnoea with co-morbidity requiring paediatric intensive care.
确定阻塞性睡眠呼吸暂停儿童行腺样体扁桃体切除术至我院（设有儿科重症监护病房设施的三级中心）的区域手术转诊模式，并制定择期儿科重症监护病房转诊和收治指南。
采用两种方法。向周边五家无内部儿科重症监护设施的医院的耳鼻喉科顾问发送了问卷。第二种方法是在我们的三级中心对2002年1月至2005年2月期间接受阻塞性睡眠呼吸暂停腺样体扁桃体切除术的部分患者进行前瞻性观察研究。这些儿童经耳鼻喉科医生临床判断被认为是高风险患者。大多数患有阻塞性睡眠呼吸暂停并伴有合并症。排除患有单纯阻塞性睡眠呼吸暂停的健康儿童。
20名顾问中有15名回复了问卷。4名基于临床病史进行转诊，5名基于脉搏血氧饱和度进行转诊，9名转诊患有综合征的儿童，4名不进行择期转诊。在接受手术的49名高风险患者中，只有12名需要入住儿科重症监护病房，无急诊儿科重症监护病房收治情况。在研究期间，没有患有单纯阻塞性睡眠呼吸暂停症状的健康儿童需要入住儿科重症监护病房。
对于阻塞性睡眠呼吸暂停腺样体扁桃体切除术的儿科重症监护病房转诊，尚无区域共识。该领域经验丰富的人员无需进行复杂的睡眠研究，仅凭临床判断就足以检测出伴有合并症、需要儿科重症监护的复杂阻塞性睡眠呼吸暂停病例。
