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OBJECTIVES To identify patients at risk for a pediatric intensive care unit (PICU) level intervention after adenotonsillectomy. STUDY DESIGN Retrospective cross-sectional study. SETTING Tertiary Children's Hospital. SUBJECTS AND METHODS Ninety-four patients who were admitted to the PICU after adenotonsillectomy were included. The need for PICU level intervention, defined as high flow oxygen by nasal cannula, positive airway pressure (PAP), heliox, and intubation, was documented. The age, gender, BMI percentile, polysomnography (PSG) data, home PAP use, and accompanying comorbidities of patients who required a PICU level intervention were compared to those who did not. RESULTS Of the 94 patients admitted post-adenotonsillectomy to the PICU, most had at least one comorbidity, with obesity being the most common. PICU admission was unplanned in 29 (30.9%) patients. Postoperatively, 25 (26.5%) patients required a PICU level intervention, with PAP being the most common intervention. On chi-square analysis, there was no significant difference in the age, BMI percentile, or PSG parameters of children who required PICU intervention. Significantly more children who used preoperative PAP were started on PAP in PICU (p = 0.018). Only the comorbidity of neuromuscular disorder was associated with PICU intervention (p = 0.04). Using binary logistic regression, the use of home PAP and an oxygen nadir <80% on preoperative PSG were found to be independent predictors of PICU intervention (p = 0.04 and 0.025, respectively). CONCLUSION Home PAP use, the presence of a neuromuscular disorder, and an oxygen nadir <80% on preoperative PSG is related to a PICU level intervention.