Routine admission to step-down unit as an alternative to intensive care unit after pediatric supraglottoplasty

Publication date: Available online 3 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Diane W. Chen, Yi-Chun Carol Liu

Abstract

Objective

To evaluate the feasibility and the outcomes for step-down (SD) unit admission as an alternative to intensive care unit (ICU) admission after supraglottoplasty in the pediatric patient. Methods: A review of 98 patients who underwent supraglottoplasty from 2012 to 2017 at a tertiary referral pediatric hospital was performed. An SD unit had 1-to-3 nurse-to-patient ratio with noninvasive positive pressure ventilation capability. Data variables included demographics, comorbidities, preoperative and postoperative respiratory requirements, and length of stay. Results: Routine admission to SD occurred for 85% patients while 15% patients were selectively admitted to ICU due to intubation requirement or perioperative respiratory distress. In SD, noninvasive respiratory support was required for 28 (34%) patients. Three (4%) required re-intubation and ICU transfer without delay in care. Patients at high risk for requiring respiratory support after surgery have a neurologic condition (OR 7.0, 95% 2.4-20.2, p<0.01) or intrinsic pulmonary disease (OR 4.5, 95% CI 1.5-13.3, p<0.01). Median length of stay was shorter for patients in step-down (1 day, IQR 1-2). Conclusion: Patients can be managed safely in a SD unit after supraglottoplasty supporting de-escalation of care. Patients with neurologic and pulmonary comorbidities may have higher respiratory needs postoperatively. Prospective studies are warranted to further optimize resource allocation.

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