@article{dbd5fd9af35b4d62803f64f90b7b52b8,
title = "Management of difficult airway among patients with oropharyngeal angioedema",
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.",
keywords = "Oropharyngeal angioedema, airway securement techniques, clinical outcomes, difficult airway, multidisciplinary",
author = "Vinciya Pandian and Gooi Zhen and Stanola Stanley and Marco Oldsman and Elliott Haut and Lynette Mark and Christina Miller and Alexander Hillel",
note = "Funding Information: Research reported in this publication was supported by the National Institute of Deafness and Other Communication Disorders of the National Institutes of Health (NIH) under award number 5K23DC014082 and 1R21DC01722501. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. In addition, research reported in this publication was supported by the Triological Society and American College of Surgeons. Funding Information: Dr. Haut is a primary investigator of a research grant (1R01HS024547) from the Agency for Healthcare Research and Quality titled “Individualized Performance Feedback on Venous Thromboembolism Prevention Practice.” Dr. Haut is a primary investigator of two contracts (CE-12-11-4489) from the Patient-Centered Outcomes Research Institute titled “Preventing Venous Thromboembolism: Empowering Patients and Enabling Patient-Centered Care via Health Information Technology” (CE-12-11-4489) and “Preventing Venous Thromboembolism (VTE): Engaging Patients to Reduce Preventable Harm from Missed/Refused Doses of VTE Prophylaxis” (DI-1603-34596). Dr. Haut receives royalties from Lippincott, Williams, & Wilkins for a book Avoiding Common ICU Errors. Dr. Haut is a paid consultant and speaker for the “Preventing Avoidable Venous Thromboembolism—Every Patient, Every Time” VHA IMPERATIV Advantage Performance Improvement Collaborative. Dr. Haut was the paid author of an article commissioned by the National Academies of Medicine titled “Military Trauma Care{\textquoteright}s Learning Health System: The Importance of Data-Driven Decision Making,” which was used to support the report titled “A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury.” Dr. Pandian is a coinvestigator for a subaward from University of Vermont/NIH for a study titled, “Novel Arm Restraint for Intubated Patients with Cognitive Impairment to Reduce Agitation, Sedation and Immobility.” Dr. Pandian received a research grant from Smith Medicals and is a paid consultant for Medtronic for tracheostomy-related questions. The authors have no other funding, financial relationships, or conflicts of interest to disclose. Publisher Copyright: {\textcopyright} 2018 The American Laryngological, Rhinological and Otological Society, Inc.",
year = "2019",
month = jun,
doi = "10.1002/lary.27622",
language = "English (US)",
volume = "129",
pages = "1360--1367",
journal = "Laryngoscope",
issn = "0023-852X",
publisher = "John Wiley and Sons Inc.",
number = "6",
}