Respiratory complications from nasal packing: systematic review.
OBJECTIVE
Patients with posterior nasal packing are thought to be at high risk for the development of respiratory complications. Controversy exists regarding the evidence in that regard; consequently, the level of vital sign monitoring required for these patients is unclear. The objective of this article is to systematically review the literature describing respiratory complications from nasal packing.


METHODS
Literature published before July 2009 on Medline and Embase was eligible for inclusion. Original research and review articles whose major topic was nasal packing for epistaxis were included. Nonhuman studies and studies not published in English were excluded. Studies were evaluated for quality using a modified Downs and Black scale. Data regarding respiratory complications of nasal packing were extracted and summarized.


RESULTS
Of the 262 studies retrieved, 14 met inclusion criteria (7 case series, 3 cohort studies, and 4 reviews). Six studies discussed pulmonary mechanics, three discussed sleep apnea, two reviews described complications of nasal packing, and three articles focused on the treatment of posterior epistaxis. There was a lack of high-quality literature describing adverse respiratory events following posterior packing.


CONCLUSIONS
The literature regarding development of respiratory complications from posterior packing is mostly based on expert opinion or case series. There is some suggestion that sleep apnea may develop after placement posterior nasal packing, but the severity appears to be mild. Evidence is lacking to support the contention that all patients with posterior packing are at risk for developing adverse respiratory events or require admission to a monitored setting.
Rotenberg
Brian
B
Department of Otolaryngology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON. Brian.Rotenberg@sjhc.london.on.ca
Tam
Samantha
S
D004844:Epistaxis / Q000628:therapy*; D006801:Humans; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000209:etiology*; D013630:Tampons, Surgical / Q000009:adverse effects*