Abstract
Background. Angioedema (AE) is a common condition which can be complicated by laryngeal edema, having up to 40% mortality. Although sporadic case reports attest to the benefits of fresh frozen plasma (FFP) in treating severe acute bouts of AE, little evidence-based support for this practice is available at present. Study Objectives. To compare the frequency, duration of intubation, and length of intensive care unit (ICU) stay in patients with acute airway AE, with and without the use of FFP. Methods. A retrospective cohort study was conducted, investigating adults admitted to large community hospital ICU with a diagnosis of AE during the years of 2007–2012. Altogether, 128 charts were reviewed for demographics, comorbidities, hospital courses, and outcomes. A total of 20 patients received FFP (108 did not). Results. Demographics and comorbidities did not differ by treatment group. However, nontreated controls did worse in terms of intubation frequency (60% versus 35%; p = 0.05) and ICU stay (3.5 days versus 1.5 days; p < 0.001). Group outcomes were otherwise similar. Conclusion. In an emergency department setting, the use of FFP should be considered in managing acute airway nonhereditary AE (refractory to steroid, antihistamine, and epinephrine). Larger prospective, better controlled studies are needed to devise appropriate treatment guidelines.
Highlights
Angioedema (AE), defined as self-limited, localized swelling, can manifest as an acute attack of asymmetric, nonpruritic, nonpitting subcutaneous or submucosal edema [1]
Given the challenge facing emergency physicians managing life-threatening acute AE with airway compromise, we investigated the use of fresh frozen plasma (FFP) to examine its ability to prevent intubation and shorten the course of airway angioedema and intensive care unit (ICU) stays
A keyword search of PubMed identified no studies comparing the frequency of intubation, duration of intubation, or the length of ICU stays in AE cases with airway involvement managed with or without FFP
Summary
Angioedema (AE), defined as self-limited, localized swelling, can manifest as an acute attack of asymmetric, nonpruritic, nonpitting subcutaneous or submucosal edema [1]. 5%–15% of patients with AE developed obstructive laryngeal edema [4], which is the leading cause of death. The latter carries a mortality rate of 25%–40% [1]. Evaluation and management of patients who present with acute airway AE may be challenging. This disorder can be caused by a wide variety of immunologic and nonimmunologic mechanisms. Duration of intubation, and length of intensive care unit (ICU) stay in patients with acute airway AE, with and without the use of FFP. Better controlled studies are needed to devise appropriate treatment guidelines
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