Arambula Alexandra M, Xie Deborah X, Whigham Amy S
Vanderbilt University School of Medicine, Nashville, TN USA; Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN, USA.
Vanderbilt University School of Medicine, Nashville, TN USA; Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Otolaryngology - Head and Neck Surgery, Pediatric Otolaryngology, Vanderbilt University Medical Center, Nashville, TN USA.
Int J Pediatr Otorhinolaryngol. 2018 Apr;107:31-36. doi: 10.1016/j.ijporl.2018.01.009. Epub 2018 Jan 31.
To characterize postoperative respiratory complications following adenotonsillectomy (AT) in children with obstructive sleep apnea (OSA) and to identify variables associated with pediatric intensive care unit (PICU) admission.
Retrospective analysis of 133 pediatric OSA patients with prior AT. Assessment of the postoperative hospital course informed patient stratification based on respiratory event severity, PICU admission status, and unscheduled escalation of care.
Thirty-six (26.8%) patients were admitted to the PICU. Compared to non-PICU admissions, these patients were significantly younger and with greater preoperative apnea-hypopnea indices, comorbidities, and percentage of post-anesthesia care unit (PACU) time requiring supplemental oxygen. Seventy-one respiratory events occurred in 59 patients, with 60.6% affecting PICU patients. Fifteen severe events occurred, affecting 31% of PICU patients. Of 14 unscheduled escalations of care, 7 were PICU admissions who, compared to planned PICU admissions, spent significantly more time in the PACU and exhibited a trend towards greater PACU time on supplemental oxygen.
Pediatric patients requiring post-AT PICU care have more risk factors for respiratory compromise. Total PACU time and total PACU time requiring supplemental oxygen may indicate patient risk for postoperative respiratory complications and need for intensive care. Future work includes prospective determination of appropriate post-AT PICU admission.
描述阻塞性睡眠呼吸暂停（OSA）患儿行腺样体扁桃体切除术（AT）后的术后呼吸并发症，并确定与儿科重症监护病房（PICU）收治相关的变量。
对133例曾行AT的儿科OSA患者进行回顾性分析。根据呼吸事件严重程度、PICU收治情况和非计划的护理升级对术后住院过程进行评估，据此对患者进行分层。
36例（26.8%）患者被收治入PICU。与未入住PICU的患者相比，这些患者年龄显著更小，术前呼吸暂停低通气指数更高，合并症更多，且麻醉后护理单元（PACU）需要补充氧气的时间百分比更高。59例患者发生了71次呼吸事件，其中60.6%影响PICU患者。发生了15次严重事件，影响了31%的PICU患者。在14次非计划的护理升级中，7次是PICU收治患者，与计划入住PICU的患者相比，这些患者在PACU的时间显著更长，且在PACU补充氧气的时间有增加趋势。
AT术后需要PICU护理的儿科患者发生呼吸功能不全的风险因素更多。PACU总时间和PACU需要补充氧气的总时间可能表明患者术后呼吸并发症的风险以及对重症监护的需求。未来的工作包括前瞻性确定AT术后合适的PICU收治标准。
