OSA in the ICU

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We've had a rash of elective surgeries that have had to stay overnight in the ICU because the patients have OSA. The policy states they have to be in ICU even though they have q shift vitals! I'm talking about tonsillectomies and vasectomies. Anyone else experience this, and any suggestions on what to do about it? (Ha...yeah right.)

Specializes in Critical Care, Progressive Care.
I can speak from personal experience that an adult tonsillectomy can be nasty. 12 hours on a vent and 24 hours in ICU, I was miserable. I also got some attitude from an ICU RN about occupying an ICU bed for "just a tonsillectomy.

Sorry you had a rough time - and I am even sorrier that your ICU RN was a moron. Adult tonsillectomy is serious stuff. I had a pt in the ED who nearly exsanguinated at home post day surgery tonsillectomy. Poor fellow spent a week in the ICU. Not good.

Is there any evidence that suggests OSA pts need to be in the ICU? I wonder how strong it is. One would think the insurance companies would not be happy about this.

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Is there any evidence that suggests OSA pts need to be in the ICU? I wonder how strong it is. One would think the insurance companies would not be happy about this.

For us it is patient by patient assessment based on if there are other comorbidities that can be exacerbated post op by the surgery or the meds. Pulmonary Hypertension is one that is a concern. Obese patients even without the OSA present more risks.

We also can monitor most of these patients on tele but occasionally a patient presents as more high risk so it might also depend on you hospital's policies. Some med-surg floors do not allow, by policy, unattended pulse oximetry and ETCO2. They have a good point because if no one is watching the monitor, it will be the best witness against you in court if something happens.

You may actually only see a very small percentage of all the OSA patients who have surgery. If you saw all of them you would probably have to expand the ICU 2x. So I doubt if this is a blanket statement that all OSA patients go into the ICU. However, you should be able to ask on of the doctors and check the policies on the various floors.

I'll do a literature search later when I'm connected to all the journals online at the hospital and see if I can get you more info.

This is one article that did come up on a free med search engine and there are several references at the end of it also.

http://www.anecare.com/Products/OSA-Protocol.pdf

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