Angioedema of the Upper Aerodigestive Tract: Risk Factors for Intubation and Review of Management Algorithm

Abstract

Objectives: To define the risks associated with angioedema related airway obstruction and intervention, and to delineate the treatment algorithm used at our institution for airway management in patients with angioedema. Methods: Retrospective chart review of consecutive otolaryngology consultations for angioedema in the emergency department (ED) from 1999-2003. All patients were evaluated by an otolaryngologist and underwent fiberoptic laryngoscopy. Results: 177 patients were included in our study. 32 (18%) patients required intubation, 25 (14%) on initial presentation and 7 (4%) patients progressed from an initially stable airway to requiring intervention after reevaluation. ANOVA analysis demonstrated a statistically significant variance between location of edema and rate of intubation, with higher rates in the pharynx and larynx versus the lip and face. There was no difference between pharyngeal and laryngeal edema in rate of intubation, and there was no difference between oral cavity edema and other subsite in rate of airway intervention. Patients who required intubation after progression between serial evaluations were more statistically more likely to have edema that involved deeper portions of the aerodigestive tract. Patients who required intubation were statistically more likely to be older (average age 61.8 vs 55.1, P=0.03). Conclusions: In this large series of patients managed for aerodigestive angioedema we demonstrate risk factors associated with airway intervention and risk factors associated with clinical progression on serial examination to airway intervention. In addition, we demonstrate a successful management algorithm for patients with aerodigestive angioedema.