scholarly journals Is the Jury Out or In?

2019 ◽  
pp. 743-760
Author(s):  
Anna M. May ◽  
Thomas R. Gildea ◽  
Reena Mehra
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Obstructive Sleep Apnea ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Perioperative Complications ◽  
Health Care Expenditures ◽  
Level Of Care ◽  
Obstructive Sleep ◽  
Respiratory Management

This case illustrates potential perioperative complications associated with obstructive sleep apnea (OSA): respiratory decompensation sometimes leading to morbidity, mortality, increase in the level of care, and increased health care expenditures. OSA is common and affects more than 40% of the surgical population. However, an estimated 85% of those with OSA are undiagnosed preoperatively. This chapter describes an individual with severe OSA complicated by perioperative respiratory failure who required intensive care unit admission and emergent reintubation. This case is used to highlight perioperative considerations for OSA screening, testing, and treatment with a focus on respiratory management based on guideline recommendations. This case underscores the most common types and timing of such postoperative complications and ways to prevent and treat them.

Intensive Care Unit Resources and Costs

PEDIATRICS ◽  
1987 ◽  
Vol 79 (2) ◽  
pp. 312-312
Author(s):  
MURRAY M. POLLACK ◽  
PAMELA R. GETSON ◽  
URS E. RUTTIMANN
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Care Expenditures ◽  
Recent Analysis ◽  
Objective Method ◽  
Appropriate Care ◽  
Potential Resource ◽  
National Issue

To the Editor.— Dr Bushore's perceptive and progressive commentary on the need to reduce health care expenditures while assuring appropriate care for appropriate patients should be applauded.1 Too little emphasis on this important, national issue has been given in the pediatric literature. Dr Bushore's commentary referred to only one paper, our recent analysis of inappropriate intensive care unit (ICU) admissions2 and emphasized the importance of an objective method for evaluations of potential resource reduction. The use of objective methods for these evaluations should be expanded upon.

Postoperative treatment of the patient with obstructive sleep apnea

2000 ◽  
Vol 122 (2) ◽  
pp. 233-236 ◽  
Author(s):  
Keith M. Ulnick ◽  
Richard F. Debo
Keyword(s):  
Intensive Care Unit ◽  
Obstructive Sleep Apnea ◽  
Intensive Care ◽  
Sleep Apnea ◽  
Sleep Apnea Syndrome ◽  
Study Groups ◽  
Postoperative Treatment ◽  
Arterial Oxygen ◽  
Obstructive Sleep ◽  
Increased Risk

>OBJECTIVE The postoperative management of patients with obstructive sleep apnea syndrome (OSAS) has been based primarily on the potential loss of the airway. Our hypothesis is that not all patients with OSAS require placement in the intensive care unit after surgery. METHODS We undertook a prospective, nonrandomized study (N = 38). Data included demographics, polysomnograms, body mass index (BMI), and postoperative course, including any complications within 72 hours. RESULTS The average respiratory disturbance index was 66, and the average BMI was 29. The average preoperative and postoperative maximal arterial oxygen desaturation values were 82% and 94%, respectively. Patients with BMIs less than 35 did not have desaturation values below 90%. No complications occurred. DISCUSSION Within the first 72 hours after surgery, no complications were observed in our study groups. Patients with BMIs greater than 35 were at increased risk for postoperative desaturations. The uncomplicated OSAS patient, one without significant comorbid factors, can be treated in a safe and prudent fashion outside of an intensive care unit.

Intensive care unit stay not required for patients with obstructive sleep apnea after laparoscopic Roux-en-Y gastric bypass

2010 ◽  
Vol 6 (2) ◽  
pp. 165-170 ◽  
Author(s):  
Brandon T. Grover ◽  
Danielle M. Priem ◽  
Michelle A. Mathiason ◽  
Kara J. Kallies ◽  
Gregory P. Thompson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Obstructive Sleep Apnea ◽  
Gastric Bypass ◽  
Intensive Care ◽  
Sleep Apnea ◽  
Intensive Care Unit Stay ◽  
Obstructive Sleep

Predicting perinatal outcomes with an obstructive sleep apnea screening tool

2021 ◽  
pp. 096914132110439
Author(s):  
Dara J Seybold ◽  
Luis A Bracero ◽  
Peter Power ◽  
Zachary A Koenig ◽  
Byron C Calhoun ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Obstructive Sleep Apnea ◽  
Intensive Care ◽  
Confidence Interval ◽  
Neonatal Intensive Care Unit ◽  
Preterm Delivery ◽  
Neonatal Intensive Care ◽  
Perinatal Outcomes ◽  
Odds Ratios ◽  
Obstructive Sleep

The objective was to determine if a screening tool for obstructive sleep apnea could be used to predict adverse perinatal outcomes. This was a prospective observational study of patients receiving prenatal care and universally screened for obstructive sleep apnea with the STOP Questionnaire (four questions related to Snoring, Tiredness during daytime, Observed apnea, and high blood Pressure). Confounding variables were included in a backwards logistic regression model to predict adverse perinatal outcomes. The study population of 442 women had positive STOP screens (64; 14.5%) associated with preterm delivery and neonatal intensive care unit admissions. For preterm delivery, history of preterm delivery was the strongest predictor with odds ratios of 4.2 (95% confidence interval 2.0–8.8; p < 0.001), followed by STOP, odds ratios 2.8 (95% confidence interval 1.4–5.8; p = 0.004) and nulliparity, odds ratios 2.3 (95% confidence interval 1.2–4.4; p = 0.013). A positive STOP was the only significant predictor for neonatal intensive care unit admissions, odds ratios 2.5 (95% confidence interval 1.1–5.7; p = 0.036). STOP screening test performance indicated low sensitivity but high specificity: preterm delivery (28.3%, 87.4%), neonatal intensive care unit admissions (27.3%, 86.6%), low birth weight (25.0%, 86.9%), and preeclampsia (16.7%, 85.6%). As a stand-alone tool, the STOP Questionnaire has limited performance, but could be explored in combination with other factors that might increase sensitivity to predict preterm delivery and neonatal intensive care unit admission.

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