Gayen Shameek, Sinha Tejas, Dronamraju Veena, Lashari Bilal, Zhao Huaqing, Dhungana Santosh
Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, USA.
Health Sciences, Temple University, Philadelphia, USA.
Cureus. 2022 Apr 2;14(4):e23759. doi: 10.7759/cureus.23759. eCollection 2022 Apr.
Background Airway compromise and respiratory failure are feared complications of angioedema leading to intensive care unit (ICU) admission. However, few of these patients decompensate. There is a paucity of tools that predict airway compromise in patients with angioedema, and it is unclear if automatic triage to the ICU is warranted. We analyzed patients admitted to our tertiary center ICU with angioedema for "airway watch" to find a way to triage those at greatest risk of respiratory decompensation. Methods We performed a retrospective review of patients with angioedema admitted to our ICU between 2017 and 2020. Data collected included demographics, comorbidities, nasopharyngolaryngoscopy (NPL) findings, need for intubation, and length of stay. Descriptive analysis and subsequent ANOVA or T-test statistical analysis was performed to determine the relationships between individual variables and outcomes. Categorical variables were compared using Pearson's Chi-squared test or Fisher's exact test where applicable. Continuous variables were compared using a Mann-Whitney U test. Results Of 134 patients admitted to our ICU, 63 (47%) required intubation, primarily in the emergency department (92.1%). Of those who required intubation, 61.9% had abnormal NPL findings in contrast to 25.35% of patients who did not require intubation (p<0.0001). Normal NPL findings had a negative predictive value for requiring intubation of 86.5%. Abnormal NPL findings had a positive predictive value for requiring intubation of 68.4%. Conclusion While airway compromise is a serious complication of angioedema, there is scant evidence to support triage to the ICU for those not intubated immediately. The majority of patients with angioedema who required intubation had abnormal NPL findings, and the majority of those with normal NPL findings did not require intubation. This suggests that NPL findings in patients with angioedema can help with triage to the ICU.
气道梗阻和呼吸衰竭是血管性水肿令人担忧的并发症，可导致患者入住重症监护病房（ICU）。然而，这些患者中很少有人会出现病情恶化。目前缺乏预测血管性水肿患者气道梗阻的工具，对于是否有必要将患者自动分诊至ICU也尚不明确。我们对入住我院三级中心ICU进行“气道观察”的血管性水肿患者进行了分析，以找到一种方法来分诊那些呼吸失代偿风险最高的患者。方法：我们对2017年至2020年间入住我院ICU的血管性水肿患者进行了回顾性研究。收集的数据包括人口统计学资料、合并症、鼻咽喉镜检查（NPL）结果、插管需求和住院时间。进行描述性分析以及随后的方差分析或T检验统计分析，以确定各个变量与结果之间的关系。分类变量在适用时使用Pearson卡方检验或Fisher精确检验进行比较。连续变量使用Mann-Whitney U检验进行比较。结果：在我院ICU收治的134例患者中，63例（47%）需要插管，主要在急诊科（92.1%）。在需要插管的患者中，61.9%的NPL检查结果异常，而不需要插管的患者中这一比例为25.35%（p<0.0001）。NPL检查结果正常对需要插管的阴性预测值为86.5%。NPL检查结果异常对需要插管的阳性预测值为68.4%。结论：虽然气道梗阻是血管性水肿的严重并发症，但几乎没有证据支持对未立即插管的患者分诊至ICU。大多数需要插管的血管性水肿患者NPL检查结果异常，而大多数NPL检查结果正常的患者不需要插管。这表明血管性水肿患者的NPL检查结果有助于分诊至ICU。
