Should Patients with Posterior Nasal Packing Require ICU Admission?

Background

Ten percent of all episodes of epistaxis occur in the posterior nose, making posterior epistaxis a commonly encountered emergency for both emergency department physicians and otolaryngologists. Severe idiopathic nontraumatic posterior nasal epistaxis is an otolaryngologic emergency that occurs primarily in middle aged and elderly individuals who often have underlying chronic cardiac and respiratory comorbidities. Sudden unexplained deaths have been reported with posterior nasal packing as well as respiratory distress, hypoxia, cardiac dysrhythmias, myocardial infarction, and cerebral ischemia. Once the bleeding has been controlled with posterior packing, the decision of where to admit the patient for observation must be made. Because of the above complications, debate remains as to whether patients with posterior nasal packing require intensive care unit (ICU) monitoring.

Best Practice

The literature reporting ward admission of patients with epistaxis treated with posterior nasal packing is relatively poor. There are no prospective randomized studies specifically analyzing this question. The preponderance of published evidence suggest admitting most patients with posterior nasal packing to the otolaryngology ward, with continuous pulse oximetry, and selectively admitting some patients with serious comorbidities (heart disease, arrhythmias, OSA) or major blood loss to higher levels of care. Read the full article in The Laryngoscope.