Epistaxis, medical history, and the nasopulmonary reflex: what is clinically relevant?

摘要: Posterior epistaxis and its management are associated with increased morbidity sudden death. A "nasopulmonary reflex," changes in pulmonary function induced by packing, has been postulated to cause hypoxia lead the reported morbidities. However, no study followed patients prospectively associate complications oxygen status. Continuous pulse oximetry monitoring of 19 hospitalized posterior packing was undertaken document incidence extent desaturation, correlate O2 status historical factors. further aim clarify clinical relevance nasopulmonary reflex. In 1200 hours monitoring, desaturations less than 90% were observed on only two occasions: one self-limited episode an actively bleeding patient major hypoxic event respiratory arrest alcoholic under sedation for delirium tremens. Complications, while uncommon, more appropriately ascribed rebleeding or underlying medical problems primary The reflex, as previously described terms a drop O2, therefore seems clinically irrelevant. Early surgery is not warranted basis maintenance adequate oxygenation alone.