HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Fig. 3. Flowchart of number of patients consulted for otolaryngology – head and neck surgeons, number of patients whose airways were evalu- ated, and number of patients who received medications alone versus medications and intubation for interventions.

administered for angioedema management is shown in Table II. In the 10 years studied, 32 patients required airway intervention. The number of patients who required airway intervention was higher among the post-DART cohort (18 out of 27 [67%]) than in the pre-DART (14 out of 36 [39%]) ( P = 0.03). The average time taken by the post- DART (3.4 minutes) to respond to calls was shorter than by the pre-DART (89.2 minutes) cohort ( P < 0.01). Eleven patients (79%) in the pre-DART cohort were transported to the operating room, whereas only nine (50%) patients in the post-DART cohort were transported to the operating room for airway securement. The team that predomi- nantly secured an airway was an otolaryngologist in both pre-DART (64%) and post-DART (67%) cohorts (Table II). The service that fi nally established the airway did not sig- ni fi cantly differ between the two cohorts. The awake transnasal fi beroptic technique was used as the fi rst choice to intubate patients with oropharyngeal

Overall in 10 years, patients with angioedema related to ACE-I predominantly presented to the emer- gency department (24 [55.8%]). Thirty-six patients (57%) had a single site affected by angioedema; 25 (40%) had two sites involved; and only two patients (3%) had three or more sites involved. Speci fi c sites involved for each cohort are listed in Table I. There was no statistical dif- ference in the number or anatomic sites involved between the pre- and post-DART cohorts. Airway Evaluation and Intervention Fiberoptic laryngoscopic airway evaluations were per- formed more frequently in the post-DART cohort (n = 22 [82%]) than in the pre-DART cohort (n = 20 [56%]) ( P = 0.03). The number of patients who required pharmaco- logic management alone without any need for airway inter- vention is displayed in Figure 3. The type of medications

TABLE II. Intervention Characteristics.

Pre-DART

Post-DART

Intervention Characteristics

(n = 36)

(n = 27)

P Value

Medications

Steroids

30 (83.3) 26 (72.2) 23 (63.9)

24 (89.0) 23 (85.2) 24 (88.9)

0.53 0.20 0.02 0.07

Histamine 1 blockers Histamine 2 blockers

Epinephrine

5 (14.0)

9 (33.3)

Time to respond in minutes

(n = 4)

(n = 25)

89.2

3.36

< 0.01

Location of airway securement

(n = 14)

(n = 18)

Floor

1 (7.1)

1 (5.6)

0.12

Emergency room

2 (14.3)

2 (11.1) 6 (33.3)

Intensive care unit

0

Operating room

11 (78.6) (n = 14) 4 (28.6) 9 (64.3)

9 (50)

Service that fi nally established airway

(n = 18)

Anesthesiology

6 (33.3)

0.51

OHNS

12 (66.7)

Emergency medicine

1 (7.1)

0

Results are presented in frequency (percentages) except for Time to respond, which is reported as mean. DART = dif fi cult airway response team; OHNS = otolaryngology head and neck surgery.

Laryngoscope 129: June 2019

Pandian et al.: Dif fi cult Airway

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