Levi Eric, Alvo Andrés, Anderson Brian J, Mahadevan Murali
Department of Paediatric Otolaryngology, Starship Children's Hospital, Auckland, New Zealand.
Department of Paediatric Intensive Care, Starship Children's Hospital, Auckland, New Zealand.
SAGE Open Med. 2020 May 20;8:2050312120922027. doi: 10.1177/2050312120922027. eCollection 2020.
To review interventions required by children admitted for intensive care management following tonsillectomy or adenotonsillectomy either as elective or unplanned admission in a tertiary children's hospital.
A retrospective chart review over a 10-year period between April 2007 and March 2017 was performed. Charts were interrogated for treatments that were administered in the paediatric intensive care unit. Respiratory support therapies such as supplemental oxygen administration, high-flow nasal oxygen, positive pressure ventilation, continuous positive airway pressure, airway interventions and tracheal intubation were reviewed.
There were 103 children admitted to the paediatric intensive care unit following tonsillectomy or adenotonsillectomy. The average age was 6.2 years (range 7 months-17 years). The main indications for the procedure were sleep disordered breathing or obstructive sleep apnoea syndrome. In all, 53 children had syndromes with medical comorbidities, 31 were current continuous positive airway pressure users and 5 had a tracheostomy in situ. Forty children admitted to paediatric intensive care unit did not require any high-level care. Ten children who had an unplanned admission had their respiratory interventions started in the theatre or in the post-anaesthetic care unit, before paediatric intensive care unit admission, and did not require escalation of care.
Children may not require admission for intensive care after tonsillectomy if they have had an incident-free period in the post-anaesthetic care unit. Some of those who required high-flow nasal oxygen could have been managed on the ward provided with adequate training and monitoring facilities. The level of care they require in post-anaesthetic care unit reflected the level of care for the immediate postoperative period in the paediatric intensive care unit.
回顾在一家三级儿童医院接受扁桃体切除术或腺样体扁桃体切除术后因择期或非计划入院而需重症监护管理的儿童所需要的干预措施。
对2007年4月至2017年3月这10年期间进行了回顾性病历审查。查阅病历以了解在儿科重症监护病房所给予的治疗。对呼吸支持疗法进行了审查，如补充氧气、高流量鼻导管吸氧、正压通气、持续气道正压通气、气道干预和气管插管。
103名儿童在扁桃体切除术或腺样体扁桃体切除术后入住儿科重症监护病房。平均年龄为6.2岁（范围7个月至17岁）。手术的主要指征是睡眠呼吸障碍或阻塞性睡眠呼吸暂停综合征。总共有53名儿童患有合并内科疾病的综合征，31名是目前持续气道正压通气的使用者，5名有气管造口术。40名入住儿科重症监护病房的儿童不需要任何高级护理。10名非计划入院的儿童在入住儿科重症监护病房之前，在手术室或麻醉后护理单元就开始了呼吸干预，并且不需要加强护理。
如果儿童在麻醉后护理单元没有出现问题，扁桃体切除术后可能不需要入住重症监护病房。一些需要高流量鼻导管吸氧的儿童，如果有足够的培训和监测设施，在病房也可以得到处理。他们在麻醉后护理单元所需的护理水平反映了儿科重症监护病房术后即刻的护理水平。
