Predicting airway risk in angioedema: Staging system based on presentation

Abstract

Angioedema is an immunologically mediated, anatomically limited, nonpitting edema that can lead to life-threatening airway obstruction. To predict the risk of airway compromise in angioedema, we retrospectively reviewed 93 episodes in 80 patients from 1985 to 1995. Intubation or tracheotomy was necessary in 9 (9.7%) cases. Angiotensin-converting enzyme inhibitor use in 36 cases (39%) was associated with intensive care unit (ICU) admission (P = 0.05). ICU stay correlated significantly with presentation with voice change, hoarseness, dyspnea, and rash (P < 0.05). Voice change, hoarseness, dyspnea, and stridor were present in patients requiring airway intervention (P < 0.05). On the basis of our data, we propose a staging system by which airway risk may be predicted from the anatomic site of presentation. Patients with facial rash, facial edema, lip edema (stage I), and soft palate edema (stage II) were treated as outpatients and on the hospital ward. Patients with lingual edema (stage III) usually required ICU admission. All patients with laryngeal edema (stage IV) were admitted to the ICU. Airway intervention was necessary in 7% of stage III patients and in 24% of stage IV cases. No deaths were caused by angioedema. Airway risk in angioedema may be predicted by anatomic site of presentation, allowing appropriate triage with preparation for airway intervention in selected cases.

Brief review: Angiotensin converting enzyme inhibitors and angioedema: anesthetic implications

“…Ishoo et al reviewed 93 episodes of angioedema over a ten-year period, and proposed a staging system by which airway risk could be predicted from the site of presentation. 60 In this study, symptoms such as stridor, change in voice, hoarseness and dys-pnea were found to be predictive of patients with severe angioedema, and correlated with a need for airway intervention and intensive care unit (ICU) admission. Patients with facial rash, facial edema, lip edema (stage I), and soft palate edema (stage II) were treated as outpatients, and on the hospital ward.…”

“…7,8 Angioedema may be caused by other drugs as well, particularly aspirin and non-steroidal anti-inflammatory medications, radio-contrast media, angiotensin II receptor antagonists, and certain antibiotics. 60 Several cases of severe angioedema have been reported following treatment with fibrinolytic agents, 61,62 and a possible association with the use of estrogens, other antihypertensive drugs, psychotropics, and non-steroidal anti-inflammatory drugs has been suggested. 63 However there remains a relative paucity of knowledge regarding which specific drugs can precipitate angioedema, reflecting in part, the sporadic and random reporting of adverse events.…”

Angioedema Due to use of ACE-Inhibitor

“…Hastamızda medikal tedaviye yanıt alındığı için entübayon yada trakeotomiye ihtiyaç duyulmamıştır. İshoo E. ve arkadaşla-rı hastanın başvuru bulgularının anatomik lokalizasyonuna göre, ilerleyen dönemde ne kadar hava yolu desteğinin ihtiyaç duyacaklarını öngören bir evreleme sistemi önermişlerdir [7] (Tablo 1). Steroid, epinefrin, H1-H2 blokerler sıklıkla ilk müdahalede kullanılan ilaçlardır.…”

ER triage in patients showing acute hypersensitivity reactions: one year's experience

“…Gli operatori sanitari dei servizi di Emergenza-Urgenza devono comunque ricordare che il rischio di un'evoluzione peggiorativa del quadro clinico è aumentato se vi è storia di anafilassi severa in circostanze analoghe a quelle attuali, o di crisi asmatiche ricorrenti in soggetti atopici, se coesistono patologie croniche a carico dell'apparato cardiovascolare, respiratorio e renale, se il paziente assume farmaci betabloccanti e ACE-inibitori [26][27][28] . Tra i rilievi fisici, sono motivo di particolare allarme la presenza e l'entità del broncospasmo (difficoltà all'eloquio, impiego della muscolatura ausiliaria), l'estensione dell'angioedema all'interno della cavità orale con interessamento della lingua e del palato molle, i segni di interessamento laringeo (disfonia, stridore inspiratorio) 29 . Risulta evidente, per i motivi anzidetti, che l'osservazione e la rivalutazione, sia prima sia dopo la visita e l'inizio del trattamento, costituiscono un aspetto importante della gestione dei pazienti con quadri acuti da ipersensibilità, indipendentemente dal codice di priorità assegnato.…”