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. 2024 May;134(5):2282-2287.
doi: 10.1002/lary.31127. Epub 2023 Oct 30.

Airway Involvement and Intervention in Non-ACE-Inhibitor-Induced Angioedema

Bartholomew J Bacak  1 , Michael S Castle  1 , Chantal Barbot  2 , Luxman Srikantha  2 , Noah A Stern  2 , Nathan D Vandjelovic  1
Affiliations

Airway Involvement and Intervention in Non-ACE-Inhibitor-Induced Angioedema

Bartholomew J Bacak et al. Laryngoscope. 2024 May.

Abstract

Objectives: Characterize the presentation of patients with non-angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema and determine risk factors associated with patient disposition and possible need for airway intervention.

Methods: The medical records of adult patients in the Emergency Department (ED) and diagnosed with non-ACEI-induced angioedema over 4.5 years were included. Demographics, vital signs, etiology, timeline, presenting symptoms, physical exam including flexible laryngoscopy, medical management, and disposition were examined. Statistical analyses were conducted using SPSS V 23.0 software calculating and comparing means, standard deviations, medians, and correlation of categorical and ordinate variables.

Results: A total of 181 patients with non-ACEI-induced angioedema were evaluated with flexible laryngoscopy by otolaryngology. Notably, 11 patients (6.1%) required airway intervention and were successfully intubated. Statistically significant factors (p ≤ 0.05) associated with airway intervention included the diastolic blood pressure (DBP) and mean arterial pressure (MAP) (p = 0.006 and 0.01 respectively), symptoms of dysphonia (p = 0.018), the presence of oropharyngeal, supraglottic, and hypopharyngeal edema (p ≤ 0.001 for each site), and the number of edematous anatomic subsites documented on physical exam (p < 0.001). Other patient demographics, prior history of angioedema, heart rate, systolic blood pressure, symptom onset, number of symptoms at presentation, and medication administered in the ED did not correlate with airway intervention.

Conclusion: Dysphonia, DBP, MAP, anatomic location of edema and edema in multiple sites are associated with airway intervention and a higher level of care in non-ACEI-induced angioedema and can be useful in risk assessment in patient management.

Level of evidence: 4 Laryngoscope, 134:2282-2287, 2024.

Keywords: airway; allergic reaction; angioedema; intubation; laryngoscopy.

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