Management of angiotensin-converting enzyme inhibitor-induced angioedema.
OBJECTIVE
To develop and validate a clinical algorithm for management of patients with angiotensin-converting enzyme inhibitor-induced angioedema (AIIA).


METHODS
Prospective cohort observational study.


METHODS
Over 1 year, 40 patients with AIIA were evaluated by otolaryngology, underwent laryngoscopy, and were followed until disease resolution. The need for airway intervention, disposition for appropriate level of care, and other parameters were analyzed.


RESULTS
Treatment started within 61.5 minutes of presentation to the emergency department (ED). Mean duration until resolution of edema was 29 hours. Twenty (50%) patients required intensive care unit (ICU) admission, and six (15%) required intubation. Seventeen (42.5%) were monitored and discharged from the ED. Floor-of-mouth edema was present in 19 (47.5%), and massive tongue edema was found in four (10%) patients. The aryepiglottic fold was involved in 20 (50%) patients on laryngoscopy. Older patients (P = .048) with subjective dyspnea (P = .003) and dysphonia (P = .001) were most likely to require ICU admission. Upper lip swelling had a negative correlation with airway edema identifiable on laryngoscopy alone (P = .008). Dysphonia (n = 16) predicted airway edema upon laryngoscopy (P = .001). All 40 patients were triaged successfully without the need for readmission or escalation of level of care.


CONCLUSIONS
The management protocol was successful in 40 consecutive patients to the appropriate level of care. History and physical examination may predict airway findings identified on laryngoscopy and help guide management when treatment by otolaryngology is not immediately available. A subset of patients will require acute airway intervention and can be identified at initial presentation.
Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan 48202, USA. sameralkhudari@gmail.com
Samer
S
Al-Khudari
Michael J
MJ
Loochtan
Edward
E
Peterson
Kathleen L
KL
Yaremchuk
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy*; D000465:Algorithms; D000799:Angioedema / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D007819:Laryngeal Edema / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D009060:Mouth Floor; D010343:Patient Admission; D011379:Prognosis; D011446:Prospective Studies; D014060:Tongue Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy
D000806:Angiotensin-Converting Enzyme Inhibitors