Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Otolaryngology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Int J Pediatr Otorhinolaryngol. 2022 Jul;158:111166. doi: 10.1016/j.ijporl.2022.111166. Epub 2022 Apr 27.
Children with obstructive sleep apnea (OSA) have higher risks of post-operative respiratory complication after adenotonsillectomy. However, there is no clinical standard criteria for pediatric intensive care unit (PICU) admission following adenotonsillectomy. The purpose of this study was to identify perioperative risk factors associated with the need for PICU level care after adenotonsillectomy.
We performed a retrospective chart review of children with severe OSA (apnea hypopnea index on polysomnography; AHI ≥10) and/or post-operative PICU admission at a tertiary academic center from May 2010 to September 2018. We collected demographics, pre-existing comorbidities, perioperative medications, and post-operative complications. We defined a primary outcome as escalation of airway management while in the PICU or PICU stay >48 h. Airway escalation included the need for an invasive airway, new CPAP application, increased CPAP setting, or increased supplemental oxygen.
Analysis included 278 children with severe OSA and/or PICU admission. Median age was 6.6 years old; 181 (65%) were admitted to the PICU, and 60 (21.5%) had the composite outcome of escalation of airway management or prolonged stay. In patients with an escalation of airway management, 28 needed intubation or mechanical ventilation. Multivariable logistic regression showed intraoperative respiratory complications, polysomnography (PSG) peak end-tidal CO (EtCO) reading >60 mmHg, and the presence of neuromuscular disease as significant associated factors for escalation of airway management or prolonged PICU stay (P values < 0.01; odd ratios 3.4, 5.3, and 5.4, respectively).
For children following adenotonsillectomy, PSG EtCO ≥ 60%, preexisting neuromuscular disease, and intraoperative complications (hypoxia, difficult airway, etc.) were independently associated with escalation of airway management or prolonged stay. AHI was not an independent predictor for PICU complication. We concluded factors should be considered for PICU admission in addition to AHI.
患有阻塞性睡眠呼吸暂停（OSA）的儿童在接受腺样体扁桃体切除术（adenotonsillectomy）后发生术后呼吸并发症的风险较高。然而，目前尚无腺样体扁桃体切除术后入住儿科重症监护病房（PICU）的临床标准。本研究旨在确定与腺样体扁桃体切除术后需要 PICU 级护理相关的围手术期危险因素。
我们对 2010 年 5 月至 2018 年 9 月在一家三级学术中心因重度 OSA（多导睡眠图上的呼吸暂停低通气指数；AHI≥10）和/或术后入住 PICU 的儿童进行了回顾性图表审查。我们收集了人口统计学资料、并存疾病、围手术期用药和术后并发症。我们将主要结局定义为在 PICU 中气道管理升级或 PICU 住院时间>48 小时。气道升级包括需要进行有创气道、新应用 CPAP、增加 CPAP 设置或增加补充氧气。
分析纳入了 278 例患有重度 OSA 和/或 PICU 入院的儿童。中位年龄为 6.6 岁；181 例（65%）被收入 PICU，60 例（21.5%）发生气道管理升级或住院时间延长的复合结局。在需要气道管理升级的患者中，有 28 例需要插管或机械通气。多变量逻辑回归显示，术中呼吸并发症、多导睡眠图（PSG）呼气末二氧化碳（EtCO）峰值>60mmHg 和存在神经肌肉疾病是气道管理升级或 PICU 住院时间延长的显著相关因素（P 值均<0.01；比值比分别为 3.4、5.3 和 5.4）。
对于接受腺样体扁桃体切除术的儿童，PSG EtCO≥60%、存在神经肌肉疾病和术中并发症（缺氧、困难气道等）与气道管理升级或住院时间延长独立相关。AHI 不是 PICU 并发症的独立预测因素。我们的结论是，除了 AHI 之外，还应考虑其他因素来决定是否将患者收入 PICU。
