Preoperative Predictors of Severe Respiratory Events After Tonsillectomy: Consideration for Pediatric Intensive Care Admission.
Preoperative Predictors of Severe Respiratory Events After Tonsillectomy: Consideration for Pediatric Intensive Care Admission.
复制标题
扁桃体切除术后严重呼吸事件的术前预测因素：考虑儿科重症监护入院。
DOI：
10.1002/ohn.238
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Chervin,RonaldD
中科院分区：
文献类型：
--
作者：
Kirkham,ErinM;Puglia,MichaelP;Haydar,Bishr;Jewell,ElizabethS;Leis,AledaM;Peddireddy,Nithin;Chervin,RonaldD
目的很少有数据可用于指导腺样体扁桃体切除术（AT）后儿科重症监护（PICU）入院。这项对儿童进行术前多导睡眠图（PSG）研究的目的是评估术前信息是否可以预测 AT 后的严重呼吸事件（SRE）。研究设计回顾性队列研究。设置单一三级中心。方法通过计费代码识别接受术前多导睡眠图（PSG）AT 的 6 个月至 17 岁儿童（2012-2018 年）。数据是从医疗记录中提取的。 SRE 被定义为任何 1 次或多次饱和度 <80% 需要干预；新开始气道正压通气；术后插管；肺炎/肺炎;呼吸衰竭、心脏骤停或死亡。我们假设 SRE 与年龄 <24 个月、主要合并症、肥胖（>95%）、呼吸暂停低通气指数 (AHI) ≥ 30 以及 PSG 的 O2nadir <70% 相关。采用多变量逻辑回归进行分析。结果 在 1774 名受试者中，28 名 (1.7%) 经历过 SRE。与未患有 SRE 的儿童相比，患有 SRE 的儿童平均年龄更小（3 岁 vs 5 岁，p< .01），出现合并症的可能性更大（59% vs 18%，p< .001）。在对性别、黑人种族、肥胖和年龄 <24 个月进行调整后，患有主要合并症的儿童比其他儿童更有可能发生 SRE（比值比 [OR]：14.2；95% 置信区间 [CI]：[5.7，35.2]），AHI ≥ 30（OR：7.7 [3.0，19.9]）或 O2nadir 的儿童也是如此。 <70%（或 6.1 [2.1， 17.9]）。年龄、肥胖、性别和黑人种族不能独立预测 SRE。 结论 对于患有复杂的医疗共病、高 AHI (>30) 和/或低 O2nadir (<70%) 的儿童来说，入住 PICU 可能是最谨慎的。
ObjectiveFew data are available to guide postadenotonsillectomy (AT) pediatric intensive care (PICU) admission. The aim of this study of children with a preoperative polysomnogram (PSG) was to assess whether preoperative information may predict severe respiratory events (SRE) after AT.Study DesignRetrospective cohort study.SettingSingle tertiary center.MethodsChildren aged 6 months to 17 years who underwent AT with preoperative polysomnography (2012‐2018) were identified by billing codes. Data were extracted from medical records. SRE were defined as any 1 or more of desaturations <80% requiring intervention; newly initiated positive airway pressure; postoperative intubation; pneumonia/pneumonitis; respiratory code, cardiac arrest, or death. We hypothesized that SRE would be associated with age <24 months, major medical comorbidity, obesity (>95th percentile), apnea‐hypopnea index (AHI) ≥ 30, and O2nadir <70% on PSG. Analysis was performed with multivariable logistic regression.ResultsOf 1774 subjects, 28 (1.7%) experienced SRE. Compared to those without, children with SRE were on average younger (3 vs 5 years,p< .01) with a greater probability of medical comorbidities (59% vs 18%,p< .001). After adjustment for sex, black race, obesity, and age <24 months, children with major medical comorbidity were more likely than other children to have SRE (odds ratio [OR]: 14.2; 95% confidence interval [CI]: [5.7, 35.2]), as were children with AHI ≥ 30 (OR: 7.7 [3.0, 19.9]), or O2nadir <70% (OR 6.1 [2.1, 17.9]). Age, obesity, sex, and black race did not independently predict SRE.ConclusionPICU admission may be most prudent for children with complex medical co‐morbidities, high AHI (>30), and/or low O2nadir (<70%).