Management of difficult airway among patients with oropharyngeal angioedema

Vinciya Pandian, Gooi Zhen, Stanola Stanley, Marco Oldsman, Elliott Haut, Lynette Mark, Christina Miller, Alexander Hillel

Research output: Contribution to journalArticlepeer-review

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, 129:1360–1367, 2019.

Original languageEnglish (US)
Pages (from-to)1360-1367
Number of pages8
JournalLaryngoscope
Volume129
Issue number6
DOIs
StatePublished - Jun 2019

Keywords

  • Oropharyngeal angioedema
  • airway securement techniques
  • clinical outcomes
  • difficult airway
  • multidisciplinary

ASJC Scopus subject areas

  • Otorhinolaryngology

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