Brill-Edwards Madeleine, Hamilton W Chase, Yoo Erika J, Costello Jennifer, Koenig George J, Cohen Murray J, Marks Joshua A
Eastern Virginia Medical School, Norfolk, VA, USA.
Department of Anesthesia, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA USA; Bethlehem Campus, St. Luke's University Health Network, Fountain Hill, PA, USA.
J Crit Care Med (Targu Mures). 2025 Jul 31;11(3):240-246. doi: 10.2478/jccm-2025-0023. eCollection 2025 Jul.
Angioedema has potential for rapid airway decompensation requiring intervention. Patients are often admitted to an ICU for "airway watch." There is a lack of evidence to support which patients require this.
We aimed to characterize admission patterns and outcomes of angioedema patients at our institution to assess resource utilization and necessity of ICU use. We hypothesized that patients not requiring intubation upon presentation are safe to manage outside the ICU.
Retrospective chart review of patients admitted to our urban academic quaternary referral institution with angioedema ICD-10 codes between 2017 and 2020. Charts reviewed for demographics, etiology, admission location, level of care, length of stay (LOS), intubation information, discharge destination, and specific treatment administered. Statistical analysis included a t-test for continuous variables (LOS).
Of 135 encounters for angioedema, 117 patients were admitted. 50 were admitted to an ICU. Patients were evenly split based on sex, majority black, and the most common etiology was ACE-inhibitor use. 20 required airway intervention with intubations primarily outside the ICU setting and only 2 in the ICU. 1 surgical airway performed in the ED. The mean time from presentation to intubation was 2.7 hours (Min 0h; Max 7.5h). The average ICU LOS for non-intubated patients was 1.1 days, with hospital LOS 1.5 days compared to 0.25 days for those not admitted to an ICU (p<0.001). For intubated patients, average ICU LOS was 4.3 days, with hospital LOS 6.2 days. All intubated patients were successfully liberated from the ventilator. No deaths occurred.
Most angioedema encounters did not require airway intervention within the first hours of presentation. Airway decompensation and intervention mostly occurred prior to the ICU setting. ICU resources should be carefully allocated and may be unnecessary for patients presenting with angioedema who are not intubated on initial evaluation.
血管性水肿有可能迅速导致气道失代偿，需要进行干预。患者通常因“气道观察”而入住重症监护病房（ICU）。目前缺乏证据支持哪些患者需要这样做。
我们旨在描述我院血管性水肿患者的入院模式和结局，以评估资源利用情况以及入住ICU的必要性。我们假设就诊时不需要插管的患者在ICU以外进行管理是安全的。
对2017年至2020年间入住我院城市学术四级转诊机构且诊断为血管性水肿（ICD - 10编码）的患者进行回顾性病历审查。审查的病历包括人口统计学、病因、入院地点、护理级别、住院时间（LOS）、插管信息、出院目的地以及所给予的具体治疗。统计分析包括对连续变量（住院时间）进行t检验。
在135例血管性水肿病例中，117例患者入院。50例入住ICU。患者按性别均匀分布，大多数为黑人，最常见的病因是使用血管紧张素转换酶抑制剂（ACE - inhibitor）。20例需要气道干预并插管，主要在ICU以外进行，仅2例在ICU进行。1例在急诊科进行了外科气道干预。从就诊到插管的平均时间为2.7小时（最短0小时；最长7.5小时）。未插管患者在ICU的平均住院时间为1.1天，住院时间为1.5天，而未入住ICU的患者住院时间为0.25天（p<0.001）。对于插管患者，ICU平均住院时间为4.3天，住院时间为6.2天。所有插管患者均成功脱机。无死亡病例。
大多数血管性水肿病例在就诊后的最初数小时内不需要气道干预。气道失代偿和干预大多发生在进入ICU之前。ICU资源应谨慎分配，对于初次评估时未插管的血管性水肿患者可能无需使用。
