(1255) Angioedema: Is ICU Admission Warranted? A Single-Institution Assessment

Introduction: Angioedema is a disease process with potential for rapid airway decompensation and need for an emergent airway. Patients often are admitted to an ICU for airway watch. There is a lack of evidence to support which patients require ICU admission. We aimed to characterize admission patterns and outcomes of patients with angioedema at our urban academic quaternary referral center to assess resource utilization and necessity of ICU level of care. We hypothesized that patients with angioedema who did not require urgent intubation upon initial presentation are safe to be managed outside of the ICU.

Methods: Retrospective chart review was completed of patients admitted for angioedema based on ICD-10 codes at our institution between 2017 - 2020. Data collection included demographics, etiology, level of care, length of stay (LOS), intubation rationale and information, discharge destination, and specific treatment administered.

Results: Of 135 encounters for angioedema (representing 117 total patients), 50 were admitted to an ICU, all were evaluated by ENT, and only 20 of those required airway interventions. Patients were evenly split based on sex, the majority were Black and the most common etiology for angioedema was ACE-Inhibitor use. Intubations primarily occurred in the ED or prior to transfer to our institution. Only two intubations occurred in an ICU setting. One patient required a cricothyrotomy, which was 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 a total hospital LOS of 1.5 days compared to 0.25 days for those not admitted to an ICU (p < 0.001). ICU LOS for intubated patients was 4.3 days (IQR 2-5.25 days), with a hospital LOS of 6.2 days (IQR 2.75-8.25 days). All intubated patients were eventually successfully liberated from the ventilator. No deaths occurred.

Conclusions: Most angioedema encounters did not require airway intervention after the first few hours of hospital presentation. Intubations and airway decompensation predominantly occurred prior to ICU admission. ICU resources should be carefully allocated and may be unnecessary for patients presenting with angioedema who are not intubated on initial evaluation.