Critical care resources utilized in high-risk adenotonsillectomy patients

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Objective: Children at high risk for respiratory complication after adenotonsillectomy are often admitted to a pediatric intensive care unit (PICU) postoperatively. Although many patients receive care in such units, it is unknown how many utilize critical care resources. Methods: A review was conducted to audit intensive care needs of postadenotonsillectomy patients admitted to the PICU at a tertiary, academic, pediatric hospital between July 2013, and March 2017. Demographic information, ICU indication, polysomnogram results, and comorbidities were collected. Patients were defined as needing ICU resources based on supplemental oxygen requirements greater than 2 L between 2 to 24 hours postoperatively, more than two desaturation events in a 2-hour period, or more than hourly nursing intervention. Factors associated with utilization of ICU resources were assessed. Results: One hundred and ten patients were admitted to the PICU after adenotonsillectomy. Median age was 4.2 years, median body mass index was 90.8 percentile, and median apnea hypopnea index (AHI) was 34.3. Twenty patients (18.2%) utilized ICU resources by criteria defined. Of these patients, 14 were known to need such resources by 2 hours postoperatively (70%, negative predictive value 93.8%). Neither AHI nor obesity status was correlated with need for resources; however, resource need was associated with young age, gastrostomy tube status, and neuromuscular disorders (P = 0.048, P = 0.002 and 0.013, respectively). Conclusion: Most high-risk adenotonsillectomy patients do not utilize critical care resources despite their increased perioperative risk. Patients with respiratory complications are frequently identifiable within the first 2 hours of surgery. Level of Evidence: 4 Laryngoscope, 129:1229–1234, 2019.

Original languageEnglish (US)
Pages (from-to)1229-1234
Number of pages6
JournalLaryngoscope
Volume129
Issue number5
DOIs
StatePublished - May 1 2019

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Critical Care
Pediatric Intensive Care Units
Apnea
Laryngoscopes
Pediatric Hospitals
Gastrostomy
Comorbidity
Patient Care
Body Mass Index
Nursing
Obesity
Demography
Oxygen

Keywords

  • Adenotonsillectomy
  • efficiency
  • high risk
  • intensive care unit
  • severe obstructive sleep apnea

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

@article{27e460a72e8c4e8e8b269ae710ea8656,
title = "Critical care resources utilized in high-risk adenotonsillectomy patients",
abstract = "Objective: Children at high risk for respiratory complication after adenotonsillectomy are often admitted to a pediatric intensive care unit (PICU) postoperatively. Although many patients receive care in such units, it is unknown how many utilize critical care resources. Methods: A review was conducted to audit intensive care needs of postadenotonsillectomy patients admitted to the PICU at a tertiary, academic, pediatric hospital between July 2013, and March 2017. Demographic information, ICU indication, polysomnogram results, and comorbidities were collected. Patients were defined as needing ICU resources based on supplemental oxygen requirements greater than 2 L between 2 to 24 hours postoperatively, more than two desaturation events in a 2-hour period, or more than hourly nursing intervention. Factors associated with utilization of ICU resources were assessed. Results: One hundred and ten patients were admitted to the PICU after adenotonsillectomy. Median age was 4.2 years, median body mass index was 90.8 percentile, and median apnea hypopnea index (AHI) was 34.3. Twenty patients (18.2{\%}) utilized ICU resources by criteria defined. Of these patients, 14 were known to need such resources by 2 hours postoperatively (70{\%}, negative predictive value 93.8{\%}). Neither AHI nor obesity status was correlated with need for resources; however, resource need was associated with young age, gastrostomy tube status, and neuromuscular disorders (P = 0.048, P = 0.002 and 0.013, respectively). Conclusion: Most high-risk adenotonsillectomy patients do not utilize critical care resources despite their increased perioperative risk. Patients with respiratory complications are frequently identifiable within the first 2 hours of surgery. Level of Evidence: 4 Laryngoscope, 129:1229–1234, 2019.",
keywords = "Adenotonsillectomy, efficiency, high risk, intensive care unit, severe obstructive sleep apnea",
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Critical care resources utilized in high-risk adenotonsillectomy patients. / Lavin, Jennifer M; Smith, Craig Martin; Harris, Zena Leah; Thompson, Dana M.

In: Laryngoscope, Vol. 129, No. 5, 01.05.2019, p. 1229-1234.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Critical care resources utilized in high-risk adenotonsillectomy patients

AU - Lavin, Jennifer M

AU - Smith, Craig Martin

AU - Harris, Zena Leah

AU - Thompson, Dana M

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Objective: Children at high risk for respiratory complication after adenotonsillectomy are often admitted to a pediatric intensive care unit (PICU) postoperatively. Although many patients receive care in such units, it is unknown how many utilize critical care resources. Methods: A review was conducted to audit intensive care needs of postadenotonsillectomy patients admitted to the PICU at a tertiary, academic, pediatric hospital between July 2013, and March 2017. Demographic information, ICU indication, polysomnogram results, and comorbidities were collected. Patients were defined as needing ICU resources based on supplemental oxygen requirements greater than 2 L between 2 to 24 hours postoperatively, more than two desaturation events in a 2-hour period, or more than hourly nursing intervention. Factors associated with utilization of ICU resources were assessed. Results: One hundred and ten patients were admitted to the PICU after adenotonsillectomy. Median age was 4.2 years, median body mass index was 90.8 percentile, and median apnea hypopnea index (AHI) was 34.3. Twenty patients (18.2%) utilized ICU resources by criteria defined. Of these patients, 14 were known to need such resources by 2 hours postoperatively (70%, negative predictive value 93.8%). Neither AHI nor obesity status was correlated with need for resources; however, resource need was associated with young age, gastrostomy tube status, and neuromuscular disorders (P = 0.048, P = 0.002 and 0.013, respectively). Conclusion: Most high-risk adenotonsillectomy patients do not utilize critical care resources despite their increased perioperative risk. Patients with respiratory complications are frequently identifiable within the first 2 hours of surgery. Level of Evidence: 4 Laryngoscope, 129:1229–1234, 2019.

AB - Objective: Children at high risk for respiratory complication after adenotonsillectomy are often admitted to a pediatric intensive care unit (PICU) postoperatively. Although many patients receive care in such units, it is unknown how many utilize critical care resources. Methods: A review was conducted to audit intensive care needs of postadenotonsillectomy patients admitted to the PICU at a tertiary, academic, pediatric hospital between July 2013, and March 2017. Demographic information, ICU indication, polysomnogram results, and comorbidities were collected. Patients were defined as needing ICU resources based on supplemental oxygen requirements greater than 2 L between 2 to 24 hours postoperatively, more than two desaturation events in a 2-hour period, or more than hourly nursing intervention. Factors associated with utilization of ICU resources were assessed. Results: One hundred and ten patients were admitted to the PICU after adenotonsillectomy. Median age was 4.2 years, median body mass index was 90.8 percentile, and median apnea hypopnea index (AHI) was 34.3. Twenty patients (18.2%) utilized ICU resources by criteria defined. Of these patients, 14 were known to need such resources by 2 hours postoperatively (70%, negative predictive value 93.8%). Neither AHI nor obesity status was correlated with need for resources; however, resource need was associated with young age, gastrostomy tube status, and neuromuscular disorders (P = 0.048, P = 0.002 and 0.013, respectively). Conclusion: Most high-risk adenotonsillectomy patients do not utilize critical care resources despite their increased perioperative risk. Patients with respiratory complications are frequently identifiable within the first 2 hours of surgery. Level of Evidence: 4 Laryngoscope, 129:1229–1234, 2019.

KW - Adenotonsillectomy

KW - efficiency

KW - high risk

KW - intensive care unit

KW - severe obstructive sleep apnea

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U2 - 10.1002/lary.27623

DO - 10.1002/lary.27623

M3 - Review article

VL - 129

SP - 1229

EP - 1234

JO - Laryngoscope

JF - Laryngoscope

SN - 0023-852X

IS - 5

ER -