TY - JOUR
T1 - Expert Consensus Statement
T2 - Pediatric Drug-Induced Sleep Endoscopy
AU - Baldassari, Cristina M.
AU - Lam, Derek J.
AU - Ishman, Stacey L.
AU - Chernobilsky, Boris
AU - Friedman, Norman R.
AU - Giordano, Terri
AU - Lawlor, Claire
AU - Mitchell, Ron B.
AU - Nardone, Heather
AU - Ruda, James
AU - Zalzal, Habib
AU - Deneal, Adrienne
AU - Dhepyasuwan, Nui
AU - Rosenfeld, Richard M.
N1 - Funding Information:
Competing interests: Cristina M. Baldassari, CORE Grant Funding, Inspire Grant Funding; Stacey L. Ishman, Inspire Medical—consultant, National Institutes of Health grant support (National Heart, Lung, and Blood Institute / National Institute of Dental and Craniofacial Research); Boris Chernobilsky, Inspire Medical Systems, Inc—stock; Adrienne Deneal, salaried employee of American Academy of Otolaryngology–Head and Neck Surgery Foundation; Nui Dhepyasuwan, salaried employee of American Academy of Otolaryngology–Head and Neck Surgery Foundation.
Publisher Copyright:
© American Academy of Otolaryngology–Head and Neck Surgery Foundation 2021.
PY - 2021/10
Y1 - 2021/10
N2 - Objective: To develop an expert consensus statement on pediatric drug-induced sleep endoscopy (DISE) that clarifies controversies and offers opportunities for quality improvement. Pediatric DISE was defined as flexible endoscopy to examine the upper airway of a child with obstructive sleep apnea who is sedated and asleep. Methods: Development group members with expertise in pediatric DISE followed established guidelines for developing consensus statements. A search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements regarding DISE in children 0 to 18 years old. Topics with significant practice variation and those that would improve the quality of patient care were prioritized. Results: The development group identified 59 candidate consensus statements, based on 50 initial proposed topics, that focused on addressing the following high-yield topics: (1) indications and utility, (2) protocol, (3) optimal sedation, (4) grading and interpretation, (5) complications and safety, and (6) outcomes for DISE-directed surgery. After 2 iterations of the Delphi survey and removal of duplicative statements, 26 statements met the criteria for consensus; 11 statements were designated as no consensus. Several areas, such as the role of DISE at the time of adenotonsillectomy, were identified as needing further research. Conclusion: Expert consensus was achieved for 26 statements pertaining to indications, protocol, and outcomes for pediatric DISE. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty. Future research, ideally randomized controlled trials, is warranted to address additional controversies related to pediatric DISE.
AB - Objective: To develop an expert consensus statement on pediatric drug-induced sleep endoscopy (DISE) that clarifies controversies and offers opportunities for quality improvement. Pediatric DISE was defined as flexible endoscopy to examine the upper airway of a child with obstructive sleep apnea who is sedated and asleep. Methods: Development group members with expertise in pediatric DISE followed established guidelines for developing consensus statements. A search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements regarding DISE in children 0 to 18 years old. Topics with significant practice variation and those that would improve the quality of patient care were prioritized. Results: The development group identified 59 candidate consensus statements, based on 50 initial proposed topics, that focused on addressing the following high-yield topics: (1) indications and utility, (2) protocol, (3) optimal sedation, (4) grading and interpretation, (5) complications and safety, and (6) outcomes for DISE-directed surgery. After 2 iterations of the Delphi survey and removal of duplicative statements, 26 statements met the criteria for consensus; 11 statements were designated as no consensus. Several areas, such as the role of DISE at the time of adenotonsillectomy, were identified as needing further research. Conclusion: Expert consensus was achieved for 26 statements pertaining to indications, protocol, and outcomes for pediatric DISE. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty. Future research, ideally randomized controlled trials, is warranted to address additional controversies related to pediatric DISE.
KW - bronchoscopy
KW - drug-induced sedation endoscopy
KW - drug-induced sleep endoscopy
KW - expert consensus
KW - flexible fiberoptic endoscopy
KW - nasopharyngoscopy
KW - obstructive sleep apnea
KW - upper airway endoscopy
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U2 - 10.1177/0194599820985000
DO - 10.1177/0194599820985000
M3 - Article
C2 - 33400611
AN - SCOPUS:85098751713
SN - 0194-5998
VL - 165
SP - 578
EP - 591
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
IS - 4
ER -