Management of difficult airway among patients with oropharyngeal angioedema
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 st...
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| Veröffentlicht in: | The Laryngoscope 2019-06, Vol.129 (6), p.1360-1367 |
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| creator | Pandian, Vinciya Zhen, Gooi Stanley, Stanola Oldsman, Marco Haut, Elliott Mark, Lynette Miller, Christina Hillel, Alexander |
| description | 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 |
| doi_str_mv | 10.1002/lary.27622 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6525056</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2161064875</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4482-5b83a6cb76008f656dce756de0c4bfc3cd3183ac056de3a3b8128881973aa26b3</originalsourceid><addsrcrecordid>eNp9kV1r2zAUhsVYWdKPm_6AYdjNGLjVhyUrN4MQuq40ZTBaaK_EsSI7CraUSXZD_n2VpS3tLnYjgc6jR694ETol-IxgTM9bCNszWgpKP6Ax4YzkxWTCP6JxGrJccno_QocxrjAmJeP4ExoxzKUUlI_R9Q04aExnXJ_5OlvYurZ6aPsMbNjANoPOuyZbQ28TEbON7ZeZD369TG-6xkCbgWusNwvTwTE6qKGN5uR5P0J3Py5uZz_z-a_Lq9l0nuuikDTnlWQgdFUKjGUtuFhoU6bVYF1UtWZ6wUgiNN6dMWCVJFRKSSYlA6CiYkfo-967HqrOpNuuD9CqdbBdSqU8WPV-4uxSNf5RCU55sibB12dB8H8GE3vV2ahN24IzfoiKEkGwKGTJE_rlH3Tlh-DS9xSlVDAmuJwk6tue0sHHGEz9GoZgtetI7TpSfztK8Oe38V_Rl1ISQPbAxrZm-x-Vmk9_P-ylTxODncs</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2226336589</pqid></control><display><type>article</type><title>Management of difficult airway among patients with oropharyngeal angioedema</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Pandian, Vinciya ; Zhen, Gooi ; Stanley, Stanola ; Oldsman, Marco ; Haut, Elliott ; Mark, Lynette ; Miller, Christina ; Hillel, Alexander</creator><creatorcontrib>Pandian, Vinciya ; Zhen, Gooi ; Stanley, Stanola ; Oldsman, Marco ; Haut, Elliott ; Mark, Lynette ; Miller, Christina ; Hillel, Alexander</creatorcontrib><description>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</description><identifier>ISSN: 0023-852X</identifier><identifier>EISSN: 1531-4995</identifier><identifier>DOI: 10.1002/lary.27622</identifier><identifier>PMID: 30588625</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adult ; Aged ; Airway Management - methods ; Airway Management - standards ; airway securement techniques ; Angioedema ; Angioedema - pathology ; Angioedema - therapy ; clinical outcomes ; difficult airway ; Edema ; Female ; Fiber Optic Technology ; Humans ; Intubation ; Intubation, Intratracheal - statistics & numerical data ; Male ; Middle Aged ; multidisciplinary ; Oropharyngeal angioedema ; Oropharynx - pathology ; Patient Care Team - standards ; Patients ; Prospective Studies ; Quality Improvement ; Retrospective Studies ; Tertiary Care Centers</subject><ispartof>The Laryngoscope, 2019-06, Vol.129 (6), p.1360-1367</ispartof><rights>2018 The American Laryngological, Rhinological and Otological Society, Inc.</rights><rights>2019 The American Laryngological, Rhinological and Otological Society, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4482-5b83a6cb76008f656dce756de0c4bfc3cd3183ac056de3a3b8128881973aa26b3</citedby><cites>FETCH-LOGICAL-c4482-5b83a6cb76008f656dce756de0c4bfc3cd3183ac056de3a3b8128881973aa26b3</cites><orcidid>0000-0001-8471-5449 ; 0000-0002-2260-1080</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Flary.27622$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Flary.27622$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30588625$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pandian, Vinciya</creatorcontrib><creatorcontrib>Zhen, Gooi</creatorcontrib><creatorcontrib>Stanley, Stanola</creatorcontrib><creatorcontrib>Oldsman, Marco</creatorcontrib><creatorcontrib>Haut, Elliott</creatorcontrib><creatorcontrib>Mark, Lynette</creatorcontrib><creatorcontrib>Miller, Christina</creatorcontrib><creatorcontrib>Hillel, Alexander</creatorcontrib><title>Management of difficult airway among patients with oropharyngeal angioedema</title><title>The Laryngoscope</title><addtitle>Laryngoscope</addtitle><description>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</description><subject>Adult</subject><subject>Aged</subject><subject>Airway Management - methods</subject><subject>Airway Management - standards</subject><subject>airway securement techniques</subject><subject>Angioedema</subject><subject>Angioedema - pathology</subject><subject>Angioedema - therapy</subject><subject>clinical outcomes</subject><subject>difficult airway</subject><subject>Edema</subject><subject>Female</subject><subject>Fiber Optic Technology</subject><subject>Humans</subject><subject>Intubation</subject><subject>Intubation, Intratracheal - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>multidisciplinary</subject><subject>Oropharyngeal angioedema</subject><subject>Oropharynx - pathology</subject><subject>Patient Care Team - standards</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Quality Improvement</subject><subject>Retrospective Studies</subject><subject>Tertiary Care Centers</subject><issn>0023-852X</issn><issn>1531-4995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kV1r2zAUhsVYWdKPm_6AYdjNGLjVhyUrN4MQuq40ZTBaaK_EsSI7CraUSXZD_n2VpS3tLnYjgc6jR694ETol-IxgTM9bCNszWgpKP6Ax4YzkxWTCP6JxGrJccno_QocxrjAmJeP4ExoxzKUUlI_R9Q04aExnXJ_5OlvYurZ6aPsMbNjANoPOuyZbQ28TEbON7ZeZD369TG-6xkCbgWusNwvTwTE6qKGN5uR5P0J3Py5uZz_z-a_Lq9l0nuuikDTnlWQgdFUKjGUtuFhoU6bVYF1UtWZ6wUgiNN6dMWCVJFRKSSYlA6CiYkfo-967HqrOpNuuD9CqdbBdSqU8WPV-4uxSNf5RCU55sibB12dB8H8GE3vV2ahN24IzfoiKEkGwKGTJE_rlH3Tlh-DS9xSlVDAmuJwk6tue0sHHGEz9GoZgtetI7TpSfztK8Oe38V_Rl1ISQPbAxrZm-x-Vmk9_P-ylTxODncs</recordid><startdate>201906</startdate><enddate>201906</enddate><creator>Pandian, Vinciya</creator><creator>Zhen, Gooi</creator><creator>Stanley, Stanola</creator><creator>Oldsman, Marco</creator><creator>Haut, Elliott</creator><creator>Mark, Lynette</creator><creator>Miller, Christina</creator><creator>Hillel, Alexander</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8471-5449</orcidid><orcidid>https://orcid.org/0000-0002-2260-1080</orcidid></search><sort><creationdate>201906</creationdate><title>Management of difficult airway among patients with oropharyngeal angioedema</title><author>Pandian, Vinciya ; Zhen, Gooi ; Stanley, Stanola ; Oldsman, Marco ; Haut, Elliott ; Mark, Lynette ; Miller, Christina ; Hillel, Alexander</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4482-5b83a6cb76008f656dce756de0c4bfc3cd3183ac056de3a3b8128881973aa26b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Airway Management - methods</topic><topic>Airway Management - standards</topic><topic>airway securement techniques</topic><topic>Angioedema</topic><topic>Angioedema - pathology</topic><topic>Angioedema - therapy</topic><topic>clinical outcomes</topic><topic>difficult airway</topic><topic>Edema</topic><topic>Female</topic><topic>Fiber Optic Technology</topic><topic>Humans</topic><topic>Intubation</topic><topic>Intubation, Intratracheal - statistics & numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>multidisciplinary</topic><topic>Oropharyngeal angioedema</topic><topic>Oropharynx - pathology</topic><topic>Patient Care Team - standards</topic><topic>Patients</topic><topic>Prospective Studies</topic><topic>Quality Improvement</topic><topic>Retrospective Studies</topic><topic>Tertiary Care Centers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pandian, Vinciya</creatorcontrib><creatorcontrib>Zhen, Gooi</creatorcontrib><creatorcontrib>Stanley, Stanola</creatorcontrib><creatorcontrib>Oldsman, Marco</creatorcontrib><creatorcontrib>Haut, Elliott</creatorcontrib><creatorcontrib>Mark, Lynette</creatorcontrib><creatorcontrib>Miller, Christina</creatorcontrib><creatorcontrib>Hillel, Alexander</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Laryngoscope</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pandian, Vinciya</au><au>Zhen, Gooi</au><au>Stanley, Stanola</au><au>Oldsman, Marco</au><au>Haut, Elliott</au><au>Mark, Lynette</au><au>Miller, Christina</au><au>Hillel, Alexander</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management of difficult airway among patients with oropharyngeal angioedema</atitle><jtitle>The Laryngoscope</jtitle><addtitle>Laryngoscope</addtitle><date>2019-06</date><risdate>2019</risdate><volume>129</volume><issue>6</issue><spage>1360</spage><epage>1367</epage><pages>1360-1367</pages><issn>0023-852X</issn><eissn>1531-4995</eissn><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</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>30588625</pmid><doi>10.1002/lary.27622</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-8471-5449</orcidid><orcidid>https://orcid.org/0000-0002-2260-1080</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | The Laryngoscope, 2019-06, Vol.129 (6), p.1360-1367 |
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| source | MEDLINE; Access via Wiley Online Library |
| subjects | Adult Aged Airway Management - methods Airway Management - standards airway securement techniques Angioedema Angioedema - pathology Angioedema - therapy clinical outcomes difficult airway Edema Female Fiber Optic Technology Humans Intubation Intubation, Intratracheal - statistics & numerical data Male Middle Aged multidisciplinary Oropharyngeal angioedema Oropharynx - pathology Patient Care Team - standards Patients Prospective Studies Quality Improvement Retrospective Studies Tertiary Care Centers |
| title | Management of difficult airway among patients with oropharyngeal angioedema |
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