Steroids Have No Effect on ICU Outcomes in Intubated Patients With Angioedema

This article is part of MPR’s coverage of the CHEST Virtual 2020 meeting.

While patients with angioedema are routinely given steroids, the use of steroids in intubated patients had no effect on intensive care unit (ICU) hours, intubation length, or total length of hospital stay, according to research presented at the 2020 CHEST Annual Meeting held virtually, October 18 to 21.

In this retrospective analysis, investigators included 3290 patients with angioedema, including 1241 intubated patients, who were admitted to 185 hospitals across the United States between 2016 and 2020. Angioedema cases were identified using diagnostic codes and mechanical ventilation procedure codes were used to calculate time of intubation. The researchers performed descriptive analyses of patient characteristics, including age, sex, types of angioedema, intubation duration, steroids administration, ICU hours, and the total length of stay (LOS).

Patients in this retrospective cohort study had either allergic angioedema, unspecified angioedema, or angiotensin converting enzyme (ACE) inhibitor angioedema. Overall, 62.61% of patients received steroids. Steroids were administered in 61% of patients with allergic angioedema, 63% in unspecified angioedema, and 63% of patients with angioedema induced by ACE inhibitors.

Treatment with steroids did not demonstrate any effect on ICU hours in any subgroup; however, the investigators found that age was a significant factor for this analysis (P =.001). They added that a patient with any type of angioedema would remain in the ICU for approximately 0.51 hours longer for every additional year.

In addition, the investigators found no significant effect of steroid administration on the total LOS or length of intubation in any angioedema subgroup. Also, there were no significant differences in the rates of steroid administration among the 3 angioedema subgroups. No association was found between intubation time and type of angioedema (P =.02). In the subgroup of patients with angioedema induced by ACE inhibitors, 58% of patients were not intubated, 9% of patients were intubated for fewer than 24 hours, 25% were intubated for 24 to 96 hours, and 5% of patients were intubated for more than 96 consecutive hours.

In contrast, 68% of patients in the allergic angioedema subgroup were not intubated vs 10% who were intubated for fewer than 4 hours, 19% for 24 to 96 hours, and 3% for more than 96 consecutive hours. Intubation in the unspecified angioedema subgroup was performed for fewer than 24 hours in 9.16% of patients, 24 to 96 hours in 22% of patients and more than 96 consecutive hours in 5% of patients. A total of 64% of patients in the unspecified subgroup were not intubated.

The investigators concluded that treatment with steroids “can potentially complicate the clinical picture and expose vulnerable patient populations to side effects.”

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Reference

Jamil A, Kubomoto S, Ayutyanont N, Wilson S, Taha AT, Patel C. Large retrospective study analyzing role of steroids use in intubated patients with angioedema. Presented at: the CHEST Virtual Annual Meeting; October 18-21, 2020. Abstract 28.

This article originally appeared on Pulmonology Advisor