Management of difficult airway among patients with oropharyngeal angioedema.
Adult
Aged
Airway Management
/ methods
Angioedema
/ pathology
Female
Fiber Optic Technology
Humans
Intubation, Intratracheal
/ statistics & numerical data
Male
Middle Aged
Oropharynx
/ pathology
Patient Care Team
/ standards
Prospective Studies
Quality Improvement
Retrospective Studies
Tertiary Care Centers
Oropharyngeal angioedema
airway securement techniques
clinical outcomes
difficult airway
multidisciplinary
Journal
The Laryngoscope
ISSN: 1531-4995
Titre abrégé: Laryngoscope
Pays: United States
ID NLM: 8607378
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
accepted:
21
09
2018
pubmed:
28
12
2018
medline:
19
7
2019
entrez:
28
12
2018
Statut:
ppublish
Résumé
The objective of our study was to assess the impact of a multidisciplinary difficult airway response team (DART), a quality improvement program, in the management of patients with difficult airway associated with oropharyngeal angioedema patients. Individual retrospective cohort study. Retrospective review of patient charts from July 2003 to June 2008 (pre-DART) and retrospective review of prospectively collected data from July 2008 to June 2013 (post-DART). Patients with angioedema were identified using International Classification of Disease codes 995.1 and 277.6. Patients were included in the study if an otolaryngologist was consulted for airway management. Patients were excluded if they had a history of angioedema but no active issues. Patient characteristics, airway evaluation, and interventions (intubation/surgical airway) were compared between the pre-DART and post-DART cohort. The DART team attended to 27 patients with advanced oropharyngeal angioedema. Response time averaged 3.36 minutes. Preintubation fiberoptic airway evaluations were performed in 81% of the post-DART cohort and 56% of the pre-DART cohort. The incidence of patients requiring intubation was higher in the post-DART cohort (18 out of 27 [67%]) than the pre-DART (14 out of 36 [39%]) cohort. One emergency cricothyroidotomy was performed in each of the post-DART and pre-DART cohorts. Angioedema of the larynx is a predictor of intubation or cricothyroidotomy. Fiberoptic-guided intubation is primarily used for establishing airway in angioedema patients. A multidisciplinary standardized approach such as the DART program offers adequate time and resources for airway evaluation prior to intervention and allows fewer number of attempts to secure an airway. 3 Laryngoscope, 129:1360-1367, 2019.
Identifiants
pubmed: 30588625
doi: 10.1002/lary.27622
pmc: PMC6525056
mid: NIHMS992671
doi:
Types de publication
Evaluation Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1360-1367Subventions
Organisme : Patient-Centered Outcomes Research Institute
ID : CE-12-11-4489
Pays : United States
Organisme : NIDCD NIH HHS
ID : K23 DC014082
Pays : United States
Organisme : AHRQ HHS
ID : R01 HS024547
Pays : United States
Organisme : NIDCD NIH HHS
ID : R21 DC017225
Pays : United States
Informations de copyright
© 2018 The American Laryngological, Rhinological and Otological Society, Inc.
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