Angioedema: Is ICU admission warranted? A single institution assessment

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.