The Effects of Nasal Packing on Respiratory Function in Post-Nasal Surgery Patients: A Systematic Review and Meta-Analysis
Dr Gabriel Osie, ENT Registrar, Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Australia
Authors List
Osie, G., Liang, K., Haghighi, M.S., Darbari Kaul, R., Lindsay, B., Choy, C., Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
Rimmer, J., Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales; Woolcock Institute, University of Sydney; Faculty of Medicine, Notre Dame University, Sydney, Australia
Kalish, L.H., Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales; Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney; Faculty of Medicine, University of Sydney, Australia
Campbell, R.G., Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales; Faculty of Medicine, Health and Human Sciences, Macquarie University; Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia
Sacks, R., Faculty of Medicine, University of Sydney, Australia
Harvey, R.J., Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
Introduction: Nasal packing is often utilised after nasal surgery for reasons including haemostasis and improved wound healing. The influence of nasal packing on the nasal airway and subsequent clinical effect on respiratory function is debated.
Aims: This study aims to analyse the acute impact of post-surgical nasal packing on cardiopulmonary function.
Methods: A systematic review was performed for any original research assessing pulmonary function in patients with nasal packing. Only studies with both preoperative and bilateral nasally packed postoperative assessments were included. The primary outcomes were oxygen saturation (SpO2) and arterial blood gas parameters: PaO2 (mmHg), PaCO2 (mmHg), pH, and HCO3- (mM). A search of MEDLINE, EMBASE, Web of Science, Scopus, and CINAHL was performed from their foundation to 13th September 2023. A randomised effects model was used to predict pooled mean differences in patients with and without packing with 95% confidence intervals.
Results: Of the 9133 identified studies, 9 studies were included. There were 304 patients assessed (mean age 34 years, 38% female). Packing resulted only in a minor decrease in oxygenation compared to baseline SpO2 -1.24% [-2.14, -0.34]. There were no significant changes in arterial blood gas parameters: PaO2 -1.84mmHg [-5.69, 2.01], PaCO2 -0.88 mmHg [-3.98, 2.22], HCO3- -0.38 mmHg [-2.44, 1.67], and pH 0 [-0.02, 0.01].
Conclusion: Even in the setting of bilateral nasal packing, patients experience only a small decrease in SpO2 without any other changes to pulmonary measures.
Osie, G., Liang, K., Haghighi, M.S., Darbari Kaul, R., Lindsay, B., Choy, C., Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
Rimmer, J., Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales; Woolcock Institute, University of Sydney; Faculty of Medicine, Notre Dame University, Sydney, Australia
Kalish, L.H., Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales; Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney; Faculty of Medicine, University of Sydney, Australia
Campbell, R.G., Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales; Faculty of Medicine, Health and Human Sciences, Macquarie University; Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia
Sacks, R., Faculty of Medicine, University of Sydney, Australia
Harvey, R.J., Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
Introduction: Nasal packing is often utilised after nasal surgery for reasons including haemostasis and improved wound healing. The influence of nasal packing on the nasal airway and subsequent clinical effect on respiratory function is debated.
Aims: This study aims to analyse the acute impact of post-surgical nasal packing on cardiopulmonary function.
Methods: A systematic review was performed for any original research assessing pulmonary function in patients with nasal packing. Only studies with both preoperative and bilateral nasally packed postoperative assessments were included. The primary outcomes were oxygen saturation (SpO2) and arterial blood gas parameters: PaO2 (mmHg), PaCO2 (mmHg), pH, and HCO3- (mM). A search of MEDLINE, EMBASE, Web of Science, Scopus, and CINAHL was performed from their foundation to 13th September 2023. A randomised effects model was used to predict pooled mean differences in patients with and without packing with 95% confidence intervals.
Results: Of the 9133 identified studies, 9 studies were included. There were 304 patients assessed (mean age 34 years, 38% female). Packing resulted only in a minor decrease in oxygenation compared to baseline SpO2 -1.24% [-2.14, -0.34]. There were no significant changes in arterial blood gas parameters: PaO2 -1.84mmHg [-5.69, 2.01], PaCO2 -0.88 mmHg [-3.98, 2.22], HCO3- -0.38 mmHg [-2.44, 1.67], and pH 0 [-0.02, 0.01].
Conclusion: Even in the setting of bilateral nasal packing, patients experience only a small decrease in SpO2 without any other changes to pulmonary measures.
