■回顾扁桃体切除术或腺扁桃体切除术(T/AT)后计划入住儿科重症监护病房(PICU)的儿童需要重症监护病房水平干预的呼吸道损害的发生率和相关因素。
■回顾性队列研究。
■对2015年至2020年在三级儿科护理医院接受T/AT治疗后所有PICU入院患者的回顾。患者人口统计学,潜在的合并症,手术数据,并提取PICU住院期间的呼吸道并发症。
■77名患者在T/AT后进入PICU,年龄6.1±4.6岁。所有儿童均被诊断为阻塞性睡眠呼吸暂停或睡眠呼吸紊乱(术前平均呼吸暂停低通气指数29±26.5和O2最低点77.1%±11.1)。神经肌肉疾病,肠内饲料依赖,肥胖是常见的发现(N=240(31%),N=106(14%),和N=209(27%)。总的来说,29例患者(3.7%)出现呼吸损害,需要PICU级支持,定义为新发连续或双水平气道正压支持(n=25)或再插管(n=9)。3例患者被诊断为肺水肿。多因素回归分析显示术前氧最低点和肠内进食依赖性与呼吸损害相关(OR=0.97,95%CI0.94-0.99,P=.04;OR=6.3,95%CI2.36-52.6,P=.001)。
■我们的研究发现,在T/AT后计划入住PICU的患者中,有3.7%的患者出现呼吸损害。氧最低点和肠内进食与较高的呼吸损害率有关。在规划术后处置时应注意这些因素。
UNASSIGNED: Review the incidence and factors associated with respiratory compromise requiring intensive care unit level interventions in children with planned admission to the pediatric intensive care unit (PICU) following tonsillectomy or adenotonsillectomy (T/AT).
UNASSIGNED: Retrospective cohort study.
UNASSIGNED: Review of all patients with PICU admissions following T/AT from 2015 to 2020 at a tertiary care pediatric hospital. Patient demographics, underlying comorbidities, operative data, and respiratory complications during PICU admission were extracted.
UNASSIGNED: Seven hundred and seventy-two patients were admitted to the PICU following T/AT, age 6.1 ± 4.6 years. All children were diagnosed with obstructive sleep apnea or sleep-disordered breathing (mean pre-operative apnea-hypopnea index 29 ± 26.5 and O2 nadir 77.1% ± 11.1). Neuromuscular disease, enteral feed dependence, and obesity were common findings (N = 240 (31%), N = 106 (14%), and N = 209 (27%) respectively). Overall, 29 patients (3.7%) developed respiratory compromise requiring PICU-level support, defined as new-onset continuous or bilevel positive airway pressure support (n = 25) or reintubation (n = 9). Three patients were diagnosed with pulmonary edema. Multivariable regression analysis demonstrated pre-operative oxygen nadir and enteral feed dependence were associated with respiratory compromise (OR = 0.97, 95% CI 0.94-0.99, P = .04; OR = 6.3, 95% CI 2.36-52.6, P = .001 respectively).
UNASSIGNED: Our study found respiratory compromise in 3.7% of patients with planned PICU admissions following T/AT. Oxygen nadir and enteral feeds were associated with higher respiratory compromise rates. Attention should be given to these factors in planning for post-operative disposition.