Abstract
Objective: The objective of our study was to assess the impact of a multidisciplinary difficult airway response team (DART), a quality improvement program, in the management of patients with difficult airway associated with oropharyngeal angioedema patients. Methods: Individual retrospective cohort study. Retrospective review of patient charts from July 2003 to June 2008 (pre-DART) and retrospective review of prospectively collected data from July 2008 to June 2013 (post-DART). Patients with angioedema were identified using International Classification of Disease codes 995.1 and 277.6. Patients were included in the study if an otolaryngologist was consulted for airway management. Patients were excluded if they had a history of angioedema but no active issues. Patient characteristics, airway evaluation, and interventions (intubation/surgical airway) were compared between the pre-DART and post-DART cohort. Results: The DART team attended to 27 patients with advanced oropharyngeal angioedema. Response time averaged 3.36 minutes. Preintubation fiberoptic airway evaluations were performed in 81% of the post-DART cohort and 56% of the pre-DART cohort. The incidence of patients requiring intubation was higher in the post-DART cohort (18 out of 27 [67%]) than the pre-DART (14 out of 36 [39%]) cohort. One emergency cricothyroidotomy was performed in each of the post-DART and pre-DART cohorts. Conclusion: Angioedema of the larynx is a predictor of intubation or cricothyroidotomy. Fiberoptic-guided intubation is primarily used for establishing airway in angioedema patients. A multidisciplinary standardized approach such as the DART program offers adequate time and resources for airway evaluation prior to intervention and allows fewer number of attempts to secure an airway. Level of Evidence: 3. Laryngoscope, 2018.
| Original language | English (US) |
|---|---|
| Journal | Laryngoscope |
| DOIs | |
| State | Accepted/In press - Jan 1 2018 |
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Keywords
- airway securement techniques
- clinical outcomes
- difficult airway
- multidisciplinary
- Oropharyngeal angioedema
ASJC Scopus subject areas
- Otorhinolaryngology
Cite this
Management of difficult airway among patients with oropharyngeal angioedema. / Pandian, Vinciya; Zhen, Gooi; Stanley, Stanola; Oldsman, Marco; Haut, Elliott; Mark, Lynette J; Miller, Christina; Hillel, Alexander Tell.
In: Laryngoscope, 01.01.2018.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Management of difficult airway among patients with oropharyngeal angioedema
AU - Pandian, Vinciya
AU - Zhen, Gooi
AU - Stanley, Stanola
AU - Oldsman, Marco
AU - Haut, Elliott
AU - Mark, Lynette J
AU - Miller, Christina
AU - Hillel, Alexander Tell
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Objective: The objective of our study was to assess the impact of a multidisciplinary difficult airway response team (DART), a quality improvement program, in the management of patients with difficult airway associated with oropharyngeal angioedema patients. Methods: Individual retrospective cohort study. Retrospective review of patient charts from July 2003 to June 2008 (pre-DART) and retrospective review of prospectively collected data from July 2008 to June 2013 (post-DART). Patients with angioedema were identified using International Classification of Disease codes 995.1 and 277.6. Patients were included in the study if an otolaryngologist was consulted for airway management. Patients were excluded if they had a history of angioedema but no active issues. Patient characteristics, airway evaluation, and interventions (intubation/surgical airway) were compared between the pre-DART and post-DART cohort. Results: The DART team attended to 27 patients with advanced oropharyngeal angioedema. Response time averaged 3.36 minutes. Preintubation fiberoptic airway evaluations were performed in 81% of the post-DART cohort and 56% of the pre-DART cohort. The incidence of patients requiring intubation was higher in the post-DART cohort (18 out of 27 [67%]) than the pre-DART (14 out of 36 [39%]) cohort. One emergency cricothyroidotomy was performed in each of the post-DART and pre-DART cohorts. Conclusion: Angioedema of the larynx is a predictor of intubation or cricothyroidotomy. Fiberoptic-guided intubation is primarily used for establishing airway in angioedema patients. A multidisciplinary standardized approach such as the DART program offers adequate time and resources for airway evaluation prior to intervention and allows fewer number of attempts to secure an airway. Level of Evidence: 3. Laryngoscope, 2018.
AB - Objective: The objective of our study was to assess the impact of a multidisciplinary difficult airway response team (DART), a quality improvement program, in the management of patients with difficult airway associated with oropharyngeal angioedema patients. Methods: Individual retrospective cohort study. Retrospective review of patient charts from July 2003 to June 2008 (pre-DART) and retrospective review of prospectively collected data from July 2008 to June 2013 (post-DART). Patients with angioedema were identified using International Classification of Disease codes 995.1 and 277.6. Patients were included in the study if an otolaryngologist was consulted for airway management. Patients were excluded if they had a history of angioedema but no active issues. Patient characteristics, airway evaluation, and interventions (intubation/surgical airway) were compared between the pre-DART and post-DART cohort. Results: The DART team attended to 27 patients with advanced oropharyngeal angioedema. Response time averaged 3.36 minutes. Preintubation fiberoptic airway evaluations were performed in 81% of the post-DART cohort and 56% of the pre-DART cohort. The incidence of patients requiring intubation was higher in the post-DART cohort (18 out of 27 [67%]) than the pre-DART (14 out of 36 [39%]) cohort. One emergency cricothyroidotomy was performed in each of the post-DART and pre-DART cohorts. Conclusion: Angioedema of the larynx is a predictor of intubation or cricothyroidotomy. Fiberoptic-guided intubation is primarily used for establishing airway in angioedema patients. A multidisciplinary standardized approach such as the DART program offers adequate time and resources for airway evaluation prior to intervention and allows fewer number of attempts to secure an airway. Level of Evidence: 3. Laryngoscope, 2018.
KW - airway securement techniques
KW - clinical outcomes
KW - difficult airway
KW - multidisciplinary
KW - Oropharyngeal angioedema
UR - http://www.scopus.com/inward/record.url?scp=85059071316&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85059071316&partnerID=8YFLogxK
U2 - 10.1002/lary.27622
DO - 10.1002/lary.27622
M3 - Article
C2 - 30588625
AN - SCOPUS:85059071316
JO - Laryngoscope
JF - Laryngoscope
SN - 0023-852X
ER -