Peer-reviewed article
P140 Non-invasive Ventilation prior to Adenotonsillectomy
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Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a clinical case series describing the use of CPAP therapy in children with obstructive sleep apnea while waiting for adenotonsillectomy surgery. The study found that most children tolerated the therapy during an average 5-month wait for surgery. The research examines clinical pathways and hospital processes rather than child well-being outcomes.
Key points
- 36 children with severe OSA were initiated on CPAP therapy while awaiting adenotonsillectomy
- Mean total delay from referral to surgery was 19.6 weeks
- 86% of children were initiated on CPAP in hospital settings
- 80% of children tolerated CPAP therapy during the waiting period
- 5 patients (13.9%) were non-compliant with CPAP therapy
Limitations
This is a retrospective clinical audit of hospital procedures rather than an evaluation of child health or well-being outcomes. The document does not report on whether CPAP therapy improved children's symptoms, quality of life, or health status compared to any alternative approach.
Abstract
Abstract Introduction Prolonged wait times to ENT surgery, combined with the risk for post-operative respiratory events in children with severe OSA led to a clinical pathway of implementing CPAP therapy in children with severe OSA whilst on waiting lists for adenotonsillectomy. This study evaluated the impact of this pathway on the clinical care of these patients. Methods A retrospective review of medical records of patients under 18yrs of age diagnosed with OSA and initiated on CPAP whilst awaiting review by ENT / Adenotonsillectomy, between January 2019 and December 2020. Results 36 patients were identified, age 4.3 ± 3.2 years, 86% male, and 80.6% had comorbidities. 16 (44.4%) were overweight or obese, and for 8 (22.2%) obesity was the primary comorbidity. Mean delays: Sleep study to Referral = 4.5 ± 10.5 weeks, Referral to NIV initiation 5.6 ± 8.7 weeks, and NIV to ENT surgery 13.6 ± 13.6 weeks. Total delay from referral to the surgery was 19.6 ± 19.4 weeks. 31 (86%) children were initiated on therapy in hospital, and five (13.9%) patients were non-compliant with the therapy. Discussion Current delays to ENT surgery for children identified with OSA on sleep study average 5 months. Where OSA is sufficient to recommend ENT surgery, the majority (80%) of children tolerated CPAP therapy while they await surgery. We suggest that the benefits obtained are that therapy can be instituted more rapidly than surgery, and where children are able to use CPAP therapy it reduced the requirement for high-dependency or intensive care admission post-operatively.