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. 2017 Feb 3;1(1):2473974X17691230.
doi: 10.1177/2473974X17691230. eCollection 2017 Jan-Mar.

An Extubation Protocol for Angioedema

Elizabeth Floyd  1 , Nira A Goldstein  1 , Rauno Joks  2 , Miguel Mascaro  1   3 , Christine Liaw  1   4 , Bradley Dickson  1 , Denny Varughese  1   5 , Joshua Silverman  1   6
Affiliations

An Extubation Protocol for Angioedema

Elizabeth Floyd et al. OTO Open. .

Abstract

Angioedema-nonpitting edema of the mucous membranes and skin-most commonly occurs as a complication from the use of angiotensin-converting enzyme inhibitors. At our institution, the otolaryngology department has incorporated the use of the endotracheal tube cuff-leak test and bedside direct laryngoscopy to aid in timing for extubation of angioedema patients. Prospective data collection of patients presenting to the emergency department with angioedema was performed. Of 76 patients with angioedema, 9 required fiberoptic intubation. Intubation was performed at a median of 73 hours (range, 44-118). An endotracheal tube cuff-leak test was performed in 7 patients prior to extubation, and bedside direct laryngoscopy was also performed in 3 of these 7 patients to document resolution of laryngeal edema. The use of the endotracheal tube cuff-leak test and bedside direct laryngoscopy is an easy and inexpensive method to help determine eligibility for extubation in patients intubated for angioedema.

Keywords: angioedema; angiotensin-converting enzyme inhibitor; cuff leak; direct laryngoscopy.

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Figures

Figure 1.
Figure 1.
Paradigm for extubation in patients with angioedema. DL, direct laryngoscopy.
See this image and copyright information in PMC

References

    1. Cicardi M, Agostoni A. Hereditary angioedema. N Engl J Med. 1996;334:1666-1667. - PubMed
    1. Ochoa ME, Marín Mdel C, Frutos-Vivar F, et al. Cuff-leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis. In: Pinsky MR, Brochard L, Hedenstierna G, Antonelli M. eds. Applied Physiology in Intensive Care Medicine 1 3rd ed. Berlin, Germany: Springer; 2012:171-179. - PubMed
    1. Sandhu RS, Pasquale MD, Miller K, Wasser TE. Measurement of endotracheal tube cuff leak to predict postextubation stridor and need for reintubation. Critical Care Medicine. 1999;27:70A. - PubMed
    1. De Bast Y, De Backer D, Moraine JJ, Lemaire M, Vandenborght C, Vincent JL. The cuff leak test to predict failure of tracheal extubation for laryngeal edema. Intensive Care Med. 2002;28:1267-72. - PubMed