An Extubation Protocol for Angioedema

Floyd, Elizabeth; Goldstein, Nira A.; Joks, Rauno; Mascaró, Miguel; Liaw, Christine; Dickson, Bradley M.; Varughese, Denny; Silverman, Joshua B.

doi:10.1177/2473974x17691230

Cited by 2 publications

(3 citation statements)

References 6 publications

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“…Similarly, it can be difficult to determine when to extubate a patient with angioedema - namely when there is no obstruction of the upper airway [ 16 ]. A handful of clinical criteria are currently used to predict the safety of extubation, including the cuff leak test, respiratory rate-tidal volume ratio, and bedside direct laryngoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…A handful of clinical criteria are currently used to predict the safety of extubation, including the cuff leak test, respiratory rate-tidal volume ratio, and bedside direct laryngoscopy. We decided to extubate our patient after 36 hours, which is close to the average intubation duration in angioedema [ 16 ]. He had a negative cuff leak test and sufficiently low respiratory rate-tidal volume ratio (RVR).…”

Section: Discussionmentioning

confidence: 99%

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Role of Submandibular Ultrasound in Airway Management of a Patient With Angioedema

Lin¹,

Meyers²,

Nisar³

et al. 2022

Cureus

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Angioedema is one of several life-threatening clinical scenarios that lacks clarity on when a patient requires intubation. We present a case of angiotensin-converting enzyme-inhibitor-induced angioedema with perioral swelling and normal airway measurements on ultrasound, who was intubated with an abundance of caution and extubated successfully. Current tests for intubation and extubation, such as traditional bedside assessments and the cuff leak test, vary in reliability for angioedema and similar urgent situations. Submandibular ultrasound is a quick, low-cost, non-invasive method for determining quantitative criteria for and assessing when intubation and extubation is indicated, which may lead to improved quality of care and patient safety.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Role of Submandibular Ultrasound in Airway Management of a Patient With Angioedema

Lin¹,

Meyers²,

Nisar³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…It is known that the mechanical impact on the upper airway due to surgical or dental procedures, intubation and other interventions may provoke angioedema as it may be associated with upper airway swelling. Thus, the upper airway of HAE-C1INH patients undergoing procedures that require intubation should be monitored after extubation [43].…”

Section: Short-term Prophylaxismentioning

confidence: 99%

Expert Review and Consensus on the Treat-to-Target Management of Hereditary Angioedema: From Scientific Evidence to Clinical Practice

Caballero¹,

Lleonart-Bellfill²,

Pedrosa³

et al. 2023

J Investig Allergol Clin

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Background: Hereditary angioedema with C1 inhibitor deficiency (HAE-C1INH) is a rare disease characterized by swelling episodes. It affects quality of life (QoL) and can be lethal, when involving upper airways. Treatment is individualized, with therapeutic options including on-demand treatment (ODT), and short- and long-term prophylaxis (STP, LTP). However, available guidelines are not always clear about treatment selection, its goals or assessment of goal achievement. Objective: To review the available evidence for the management of HAE-C1INH and build a Spanish expert consensus to steer HAE-C1INH management towards a treat-to-target (T2T) approach, while addressing some of the unclear aspects of the Spanish guidelines. Methods: We reviewed the literature on the management of HAE-C1INH with a T2T approach, focusing on: 1) treatment selection and goals; and 2) available tools to assess goal achievement. We discussed the literature based on clinical experience and drew up 45 statements on undefined management aspects. A panel of 53 HAE experts validated the statements through a two-round Delphi process. Results: The goals for ODT and STP are minimizing the morbidity and mortality of attacks, and preventing attacks caused by known triggers, respectively, while the main goal of LTP is to decrease the rate, severity and duration of attacks. Furthermore, when prescribing, clinicians should consider the reduction in adverse events, while increasing patient QoL and satisfaction. Appropriate instruments for assessing goal achievement have also been indicated. Conclusions: We provide recommendations on previously unclear aspects of HAE-C1INH management with ODT, STP and LTP, focusing particularly on clinical and patient-oriented goals.

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An Extubation Protocol for Angioedema

Cited by 2 publications

References 6 publications

Role of Submandibular Ultrasound in Airway Management of a Patient With Angioedema

Role of Submandibular Ultrasound in Airway Management of a Patient With Angioedema

Expert Review and Consensus on the Treat-to-Target Management of Hereditary Angioedema: From Scientific Evidence to Clinical Practice

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