2025 Southeastern Residency Conference

Title: Comparison of purge reliability between heparin- and bicarbonate-based purge solutions during Impella support
Author Names: Jessica Donald, Breanne Mefford, Bryan Love, Jenna Cox
 
Background: Impella heart pumps are temporary mechanical circulatory support (MCS) devices used beyond procedural settings in patients with cardiogenic shock to support heart function by unloading the right or left ventricle. A solution is utilized to suppress denatured protein or thrombus deposition within the purge gaps of the Impella device. Heparin-based purge solutions are recommended by the device manufacturer, who advises against the use of non-heparin anticoagulants within the purge solution. While direct thrombin inhibitors were initially explored as a purge solution option for patients with heparin-induced thrombocytopenia, pump failures and other complications have been documented with their use. Sodium bicarbonate has emerged as an alternative, stabilizing the pump without affecting systemic heparin levels, simplifying anticoagulation management. Although FDA-approved in April 2022 for patients intolerant to heparin, data related to its clinical use remains limited.


Methods: This retrospective, observational cohort study aims to assess the efficacy of a sodium bicarbonate-based purge solution as an alternative to heparin-based purge solutions for patients receiving Impella support. The primary outcome will focus on purge reliability, defined as a composite measure of: a 25% increase in purge pressure from baseline, and/or a 50% reduction in purge flow rate (for index flow rates >15 mL/hr) or a 30% reduction (for index flow rates ≤15 mL/hr). Secondary outcomes will include the individual components of the primary composite outcome, along with the use of alteplase in the purge solution, as well as variations in purge flow rates and pressures.
 
Results: In Progress
 
Conclusion: In Progress

Title: Evaluation of Desmopressin in Preventing Overcorrection of Hyponatremia Among Patients with Renal Dysfunction


Authors: Kelsea Mabie, Tara Kennell, Rajarshi Patel, Brooke Smith, Aaron Chase, Kelli Henry


Background: Hyponatremia is a common cause for hospital and intensive care unit (ICU) admission. Treatment strategies vary based on patient presentation and the presumed cause of hyponatremia, but center around sodium repletion, fluid balance management, and discontinuation of offending agents. Increasing serum sodium must be done in a slow, controlled fashion to prevent overcorrection which may cause adverse neurological effects, including osmotic demyelination syndrome (ODS). One method to prevent sodium overcorrection includes administering desmopressin to decrease free water loss via the kidneys, avoiding hemoconcentration and rapid increase in sodium. Studies have demonstrated desmopressin is a useful agent for this indication; however, there is limited evidence on the efficacy of desmopressin in the setting of renal dysfunction.  


Methods: This was a single center, retrospective cohort study at an academic medical center that received exemption from the institutional review board. Adult patients with a serum sodium <125 mEq/L who received one or more doses of intravenous (IV) desmopressin during their admission were included. Patients were excluded if they received desmopressin for a diagnosis of diabetes insipidus or hemorrhage. The primary outcome was the difference in rate of sodium overcorrection (>8 mEq/L) 24 hours after the first desmopressin dose in patients with renal dysfunction compared to those without renal dysfunction. Renal dysfunction was defined as creatinine clearance less than 30 mL/min. Secondary outcomes included rate of correction before and after desmopressin, proportion of patients achieving a sodium correction of 5–10 mEq/L within 24 hours of presentation, and rate of overcorrection at 24 and 48 hours after presentation. Outcomes were assessed with chi-squared, t-test, and Mann-Whitney U as appropriate. All patient demographics were categorized using mean and standard deviation or median and interquartile range.


Results: Sixty-five patients were included in this study with 14 patients (21.5%) having renal dysfunction. Forty-three (66.2%) patients were male, 54 (83.1%) were admitted to the ICU, and 17 (26.2%) received a home medication associated with hyponatremia. Baseline variables including age, sex, ICU admission, renal function, baseline sodium, weight, and fluid status were well-balanced between groups. Patients in the renal dysfunction group received significantly more milliequivalents of sodium through IV fluids compared to those without renal dysfunction (90.7 vs 284.2 mEq, p=0.001), which was primarily driven by 0.9% sodium chloride administration. There was no difference in the primary outcome of rate of overcorrection 24 hours after administration of desmopressin (9.8 vs 21.4%, p=0.476). The mean change in sodium 24 hours after desmopressin was similar between groups (2.43 vs 3 mEq/L, p=0.691), with no difference in rate of overcorrection at 24 hours (9.8 vs 28.6%, p=0.173) or 48 hours (5.9 vs 14.3%, p=0.632) after admission. Correction within goal range was similar between groups at 24 hours after admission (51.0 vs 50.0%, p=1.000) and after desmopressin administration (17.6 vs 28.6%, p=0.597). There were no differences in safety outcomes. 


Conclusion: Our study did not demonstrate a difference in overcorrection of sodium after desmopressin in those with impaired versus normal renal function. Overall, there was a low incidence of overcorrection, though this study was likely underpowered. The results did not reach statistical significance however, the observed differences in sodium overcorrection rates could suggest that renal dysfunction may not influence the clinical response to desmopressin. Future studies are warranted to determine the effect of renal dysfunction on safety and efficacy of desmopressin.  

Title: Retrospective review of food bolus resolution following pharmacologic treatment in a community hospital emergency department   


Authors: Abigail E. Hall; Taylor Servais; Rachel Langenderfer; Brittany NeSmith; Ryan Lally; Evan McDonald


Objective : Identify pharmacological options available for the treatment of food bolus impactions  


Self Assessment Question: For food bolus impactions, EGD remains the definitive treatment, but during the interim period which medications are available for treatment? (answers: Glucagon; Nitroglycerin)


Background: A food bolus is a medical emergency where food is impacted in the esophagus with a sudden onset of symptoms. The definitive treatment for food bolus is esophagogastroduodenoscopy (EGD), but pharmacotherapeutic management can be utilized in the interim to attempt resolution. The American Society for Gastrointestinal Endoscopy (ASGE) guideline for management of food impactions notes administration of intravenous (IV) glucagon to induce esophageal relaxation and aid with bolus passage, but use is associated with adverse events. Although the ASGE guidelines do not discuss effectiveness of oral nitroglycerin, case reports suggest it may be useful for the management of food bolus due to its ability to cause local smooth muscle relaxation.  The purpose of this study is to evaluate resolution of food bolus among patients treated with glucagon only, glucagon and nitroglycerin, and nitroglycerin only.


Methods: This is a retrospective cohort study of adult patients presenting to a St. Francis Emergency Department (ED) with a food bolus. Patients were included if they received intramuscular (IM) or IV glucagon or oral nitroglycerin. Patients were excluded if they did not have an identified food bolus or their treatment outcomes were not recorded. The primary outcome evaluated was resolution of food bolus following pharmacologic treatment. Secondary outcomes included need for hospital admission, performance of emergent EGD, and documented adverse effects. Data was collected from May 20, 2022 to November 30, 2024, retrieved from chart review via electronic medical records, and maintained confidentially.


Results: There were a total of 89 patients screened. Six of these patients were excluded based on proposed criteria. Eighty-three patients who received nitroglycerin or glucagon for the indication of food bolus within a St. Francis ED between May 20, 2022 and November 30, 2024 were included. Twenty-three (27.7%) patients had resolution with medication administration alone. Glucagon alone was administered to 43 patients, nitroglycerin alone was administered to 9 patients, and 31 patients received both nitroglycerin and glucagon.  Resolution of food bolus following medication administration occurred in 15 (34.9%), 3 (33.3%), 5 (16.1%) of patients respectively. The secondary outcome of requiring emergent EGD occurred in 60 patients following medication administration, and of these patients, all achieved resolution following EGD. There were eight patients requiring hospital admission. Of the patients that required admission four patients received glucagon alone, and four patients received glucagon and nitroglycerin. However, patients that were admitted were for the purposes of receiving an EGD or requiring monitoring after EGD. None of the patients experienced adverse effects of headache, flushing, or hypotension with either agent. Emesis was documented following the administration of glucagon or nitroglycerin in 19 (20.4%) and 4 (9.1%) of patients respectively. 


Conclusion: This retrospective cohort study evaluated the resolution of food bolus with the administration of nitroglycerin alone, glucagon alone, or glucagon and nitroglycerin administration. No agent was found to be superior for the resolution of food bolus. Medication administration resulted in a small portion of food bolus resolution, leading to most patients requiring EGD following medication administration. However, emesis was documented more frequently following glucagon administration than following nitroglycerin administration. With minimal occurrences of resolution following any medication administration, additional factors such as medication cost and adverse effect profile should be considered when choosing a pharmaceutical agent for the treatment of a food bolus.

Title: Evaluation of Rapid Sequence Intubation Agent Selection on Hemodynamics in Emergency Room Patients


Authors: Jaclyn Gruver, Thomas Neal, Tracey Bastian, Valerie Van Vickle


Background: Rapid sequence intubation (RSI) is the process of administering a sedative induction agent and a paralytic agent to assist endotracheal intubation. The goal of induction is to induce general anesthesia, which allows for the administration of paralytics and the facilitation of optimal intubating settings. Shock index (SI) has been used by some emergency departments as a clinical severity score. It is defined as heart rate (HR) divided by systolic blood pressure (SBP) and normally ranges from 0.5 to 0.7. An SI greater than 0.9 is linked to increased risk for decompensation and poor outcomes. The purpose of this study is to evaluate the impact of induction agent selection (etomidate, ketamine, and propofol) on peri-/post- intubation hemodynamics after RSI in Emergency Room (ER) patients.


Methods: This study was an Institutional Review Board approved, single-center, retrospective chart review evaluating patients aged 18 years and older who were intubated in the ER, received one of the induction agents for RSI (etomidate, ketamine, or propofol), and survived to hospital admission. Patients who were intubated in the ER from January 1, 2022 to August 31, 2024 were identified using data from a medication dispensing cabinet report for the intubation kit, which included the induction agents. The primary objective is to evaluate the differences in pre-intubation and post-intubation shock index between etomidate, ketamine, and propofol. Secondary endpoints include: incidence of bradycardia (HR < 60 bpm) within 30 minutes of intubation, tachycardia (HR > 100 bpm) within 30 minutes of intubation, hypertension (SBP > 140 mmHg or DBP > 90 mmHg) within 30 minutes of intubation, hypotension (SBP < 90 mmHg or DBP < 60 mmHg) within 30 minutes of intubation, treatment of hypotension within 30 minutes of intubation, and dose of agent used for RSI. The safety outcome is 28 day ventilator-free days (VFD).


Results: In progress.


Conclusion: In progress.

Title: Evaluation of Pseudoephedrine as Adjunctive Therapy in Acute Spinal Cord injuries


Authors: Gianna Antinone, Taylor Law, Amanda McKinney, Mary Massaro, John Gripentrog, Stephanie Scott, and A. Shaun Rowe


Objective: To evaluate the efficacy of pseudoephedrine as an adjunctive agent to IV vasopressors in acute spinal cord injuries 


Self Assessment Question: True/False: The addition of oral pseduoephedrine to IV vasopressors for MAP augmentation post-SCI resulted in a short duration of IV vasopressors.  Answer: False


Background: Spinal cord injury (SCI) is defined as acute traumatic damage to the spinal cord, resulting in temporary or permanent neurolgical damage. Neurogenic shock, defined as bradycardia and hypotension, is common within this population. The relative recommendation immediately after injury is to augment mean arterial pressure (MAP) to a goal of 85-90 mmHg for one week to adequately perfuse the spinal cord. Commonly used treatments for MAP augmentation include intravenous (IV) and oral vasopressors such as pseudoephedrine (PSE) and midodrine. This study evaluates the efficacy of pseudephedrine as an adjunctive agent to IV vasopressors in patients with acute spinal cord injuries. 


Methods: We performed a retrospective cohort study of trauma-surgical critical care patients at the University of Tennessee Medical Center from October 1, 2015, to January 1, 2024. Patients were included if 18 years of age and older, diagnosed with a spinal cord injury, and required IV vasopressor intiation upon admission to achieve a MAP goal > 85 mmHg for the first 5 days after injury. Patients were divided into two groups of either vasopressor monotherapy or vasopressor in combination with PSE to augment the goal MAP. The primary outcome of this study compared the time to IV vasopressor discontinuation between the two groups. Secondary outcomes included incidence of central line placement and duration, ICU and hospital length of stay, all-cause ICU and hospital mortality, successful discontinuation of IV vasopressors post-pseduoephedrine initiation, IV vasopressor re-initation within 24hrs of discontinuation, and incidence of bradycardia. 


Results: Among the 751 patients identified for inclusion, 201 patients met inclusion criteria, of which 136 patients received vasopressor monotherapy, whereas 65 patients received vasopressor plus adjunctive PSE to maintain MAP goals. The duration of IV vasopressors was 70 hours versus 106 hours in the adjunctive PSE group (p=0.0299). Central line placement, duration of central line placement, hospital and ICU length of stay, hospital mortality, and ICU mortality were similar between the two groups. 80.7% of patients has successful discontinuation of vasopressors once PSE was initated. The incidence of bradycardia was more prominent in the adjunctive PSE group (44.6%) compared to vasopressors alone (25.7%), p=0.0072. 


Conclusion: Although this study did not meet the primary outcome of reducting time to IV vasopressor discontinuation, this study demonstrated successful discontionuation of vasopressors post-PSE iniation in 80% of the study population who received PSE as adjunctive therapy. This study is limited by a small sample population and retrospective nature. 

1. Title: Valproic Acid Augmentation in Traumatic Brain Injury Related Agitation
2. Authors: Michelle Allsup, Peterson Worrell
3. Background: Traumatic brain injuries (TBIs) are a prevalent issue with many patients experiencing cognitive/behavioral symptoms such as agitation, impulsiveness, and irritability. TBIs were defined as subdural hematoma, subarachnoid hematoma, skull fractures, and cerebral contusion given that it was caused by a traumatic event, such as a fall or motor vehicular collision. The purpose of this study is to identify if valproic acid (VPA) augmentation has a significant difference in these patients’ agitation.
4. Methods: This retrospective, observational, cohort study included adult trauma patients admitted to the hospital diagnosed with TBI, and initiated on of VPA and/or quetiapine for agitation. Patients were excluded if they pregnant, incarcerated, and taking any of the following prior to admission – antipsychotics, mood stabilizers, or VPA. These patients were individually chart reviewed from July 31, 2024 to January 31, 2025. The primary outcome was the time to documented resolution, in days, of agitation and the length of time until dose reductions occurred. The secondary outcomes are the incidence of adverse drug reactions (ADR) and the incidence of valproic acid discontinuation due to an ADR or persistent ADRs. As needed medications were also evaluated prior to VPA initiation and after VPA initiation.
5. Results: A total of 8 patients were included in this IRB-approved study. The included patients were then split amongst themselves to examine the before VPA initiation and after VPA initiation. The primary outcome of time to documented resolution of agitation in the pre-VPA time period was a median of 0 days and in the post-VPA time period was 1.5 days. The length of time until dose reductions occurred in the pre-VPA time period was 0 days with quetiapine and in the post-VPA time period was 3.5 days with quetiapine and 0 days with VPA. There were no documented adverse events and no discontinuations due to ADRs. There was a total of 36 doses of as needed medications (haloperidol or lorazepam) given 72 hours prior to VPA initiation and a total of 20 doses of as needed medications given 72 hours after VPA initiation.
6. Conclusion: We observed that VPA may reduce agitation in patients post-TBI whose agitation was not controlled on quetiapine alone. We found that there were more frequent dose reductions of quetiapine on discharge. There was less use of as needed medications after VPA initiation than prior to VPA initiation. A larger sample size is needed to determine if valproic acid decreases agitation in TBI patients. This should be conducted in a multicenter, prospective, randomized controlled study. This will aid in fully evaluating the benefit of VPA for agitation in patients post-TBI.

Contact: Michelle Allsup at michelle.allsup@hcahealthcare.com with any questions.

Title: Evaluation of Appropriateness of Antibiotics Prescribed at ED Discharge for Urinary Tract Infections or Community Acquired Pneumonia in Medicare Patients 65+ 

Authors: Gabrielle Hopkins, Carlen Johnson, Nicole Gonzalez

Background: Antibiotics are some of the most prescribed medications in the Emergency Department. However, providers are often required to prescribe antibiotics prior to definitive culture results. Studies have shown that inappropriate prescribing may lead to patient harm, including adverse events, treatment failure, antimicrobial resistance, and hospital readmission. Community acquired pneumonia (CAP) and urinary tract infections (UTI) are among the top discharge diagnoses with the highest 30-day all-cause readmissions. This retrospective study aims to provide insight into ED discharge antibiotic prescribing patterns in Medicare patients 65+ for CAP or UTI at AdventHealth Central Florida Division (CFD) South campuses.

Method: The study was conducted as a retrospective chart review. Reports were populated through the electronic health record identifying Medicare patients 65 years at all AdventHealth CFD South campuses who were discharged from the ED with at least one antibiotic for CAP or UTI during the period of June 1, 2023 to June 30, 2024. Patients who were less than 65 years old, pregnant, incarcerated, discharged from the ED with CAP or UTI with no oral antibiotics, or had missing documentation were excluded from the study. De-identified patient data including demographics, antibiotic agent, antibiotic dose, duration of therapy, antibiotic appropriateness based on culture results, and markers of infection were collected for assessment. The primary outcome of this study was to evaluate the appropriateness of discharge ED antibiotic prescribing for CAP or UTI within the Medicare 65+ population. The antibiotic agent, dose, frequency, duration of therapy, and appropriateness of each agent based on culture results were assessed. The secondary outcome was inappropriate renal dosing associated with discharge antimicrobial treatment. Collected data was analyzed using descriptive statistics. 

Results: A total of 158 patients met the inclusion criteria and were included in data analysis. The median age was 78 years, the median weight was 72.5 kg, and the median height was 65 inches. The most common comorbidities included cardiac [131, (82%)], neurological [45,(28%)], and diabetes [38, (24%)]. Fifty-one patients diagnosed with UTI (34%) received ceftriaxone in the emergency department prior to discharge. Upon discharge, the most prevalent antimicrobial agent prescribed for UTI was cephalexin [65,(44%)] and most common organism identified was Escherichia coli [30, (18%)]. Cystitis was found to be the most common indication for antimicrobial therapy upon discharge [133 (84%)]. Nine (5.6%) patients were diagnosed with CAP. The most prevalent agent prescribed for CAP upon discharge was azithromycin [5, (55%)] and Mycoplasma pneumoniae [1 (11%] was identified to be the most common organism for CAP. The median duration of antimicrobial therapy was 7 days for UTI and 7 days for CAP. Further analysis revealed drug-bug mismatch in 22 (28%) patients, renal function mismatch in 87 (55%) patients and no microbiologic results in 40 (25%) patients.

Conclusion: Discharge antibiotic prescribing patterns varied amongst each CFD campus for Medicare 65+ patents who were discharged home on antimicrobial therapy for UTI or CAP. Twenty-eight percent (28%) of antibiotics prescribed at discharge did not appropriately treat the culture identified pathogens. Fifty-five percent (55%) of the antibiotics were dosed inappropriately based on renal function. This demonstrates an opportunity for pharmacist involvement to improve future patient care. Future directions include opportunities to improve rates of bug-drug match selection, education and resources for ED providers on proper antibiotic selection. Lastly, standardization of order sets for discharge antibiotics for patients discharged from all CFD EDs may improve appropriate discharge antibiotic prescribing. 

Self-Assessment Question: Which was the most common bacteria identified in patients with UTI? 
A. Staphylococcus aureus 
B. Escherichia coli 
C. Klebsiella pneumoniae 
D. Proteus mirabilis

• Title: Comparative Analysis of Sedation and Analgesia Requirements in Trauma Patients Presenting with a Positive Drug Toxicology Screen 
• Authors: Sydney Kermeen, Sarah Alimenti, Michael Honaker, Kenji Leonard, and Emily Whitehead
• Objective: Compare analgesia and sedation requirements in trauma patients requiring intubation after presenting with a positive urine drug screen (UDS) and/or serum ethanol level to patients presenting with a negative toxicology screen.
• Self Assessment Question: True or False: Due to impaired drug metabolism and increased drug tolerance, trauma patients acutely intoxicated with amphetamine, cocaine, PCP, MDMA, or ethanol may have higher opioid requirements during mechanical intubation?
• Background: Pre-injury illicit substance use and intoxication are predictors of ICU admission and increased analgesia and sedation requirements in patients admitted to the hospital following traumatic injuries. Literature evaluating analgesia and sedation in patients presenting with a positive toxicology screen is limited and further research is warranted to guide treatment.
• Methods: This was a single-center, retrospective, observational study including adult patients admitted to the surgical intensive care unit (SICU) who were intubated for at least 48 hours following a trauma and presented with either a positive urine drug screen (UDS) for cannabinoids, cocaine, amphetamines, phencyclidine, ecstasy and/or elevated serum ethanol level within the first 24 hours of admission.  Patients were excluded if they had withdrawal of care or were transferred out of the SICU within 48 hours of admission, utilized short acting opiates for at least 30 days or long-acting opiates as a home medication, had a pre-diagnosed psychiatric illness, or utilized pentobarbital, chemical paralysis, or extracorporeal membrane oxygenation during the study period. The control group included patients presenting with both a negative UDS and serum ethanol level. There were two comparator groups: group 1 with both a positive UDS and serum ethanol level, and group 2 with a positive UDS and negative serum ethanol level. The primary outcome was median daily dose of opioid requirements in morphine milligram equivalents until extubation, transfer from SICU, or 30 days. Some of the secondary outcomes included mean daily benzodiazepine use, mean daily dose of continuous sedation, utilization of adjunctive analgesia and sedation agents, length of mechanical ventilation, average daily pain scores, and percentage of time within goal sedation.
• Results: A total of 151 patients were included in the analysis, with 50 patients each in the UDS(-)/EtOH(-) and USD(+)/(-) groups and 51 patients in the UDS(+)/EtOH(+) group. Baseline characteristics and patient demographics between groups were similar between groups. There were no differences in median daily MME, LME, dexmedetomidine, or ketamine use between groups; however, intoxicated patients in the UDS(+)/EtOH(+) and UDS(+)/EtOH(-) used a significantly higher median dose of propofol (30.9 [21.5, 36.7] and 33.9 [22.7, 50.0]  vs 33.9 [13.7, 33.6] mcg/kg/min). UDS(+)/EtOH(+) and UDS(+)/EtOH(-) groups also used more adjunctive agents (66.7 % and 82.0% vs 46.0%, p=0.0008) and ERAS medications (45% and 47% vs 46%, p=0.0028). Additionally, intoxicated patients achieved lower RASS levels on continuous sedation compared to non-intoxicated patients (-1 [-2.0, 1.0] and -1 [-2.0, 1.0] vs -2 [-2.8, 1.0]). Of note, the incidence of mortality was higher in the non-intoxicated group (7% and 1% vs 11%, p=0.0101). There were no differences in duration of intubation, BPS scores, ICU LOS, hospital LOS, self extubation, or trach placement.
• Conclusion: Mechanically-ventilated patients with a positive UDS and/or serum ethanol level may not have higher MME or LME requirements. However, multimodal adjunctive analgesia and sedation methods may be warranted.
  
   sydney.kermeen@ecuhealth.org
  
  

Title: Angioedema Resolution: Evaluation of Low Dose and High Dose Steroids
Authors: Cristina V. Martinez, Evan C. Hardbeck, Nicholas Filk, Neha Naik, Maria C. CreelBulos, Jasleen K. Bolina 


Background: According to the Centers for Disease Control, angioedema affects approximately 110,000 patients annually in the United States. Angioedema is characterized by self-limited swelling of the mucosal tissues in the face and larynx. It can become life-threatening if airway obstruction occurs, requiring prompt emergency care. Angioedema can be classified as either hereditary or acquired. In hereditary cases, swelling occurs due to a bradykinin response, whereas in acquired cases, it is triggered by a histamine response. Bradykinin-mediated angioedema is initially treated with a C1- esterase inhibitor, while histamine-mediated angioedema is managed with corticosteroids, antihistamines, and epinephrine. While corticosteroids are commonly used to treat angioedema there is a notable gap in current literature on optimal dosing strategies. This retrospective review aims to evaluate steroid use in angioedema patients by comparing low dose and high dose regimens to elucidate current practices, trends, and outcomes in symptom resolution.


Methods: This multicenter, retrospective, observational study included patients aged 18 years or older, diagnosed with angioedema, who received more than one dose of corticosteroids over a two-year period. Patients were excluded from the study if they were known to be pregnant or incarcerated. Patients were stratified into four groups based on their initial steroid agent and the secondary steroid treatment to which they were transitioned. Groups 1 and 2 received an initial high dose of steroids followed by a low dose in Group 2 or remained on high dose in Group 1. Groups 3 and 4 received an initial low dose followed by a high dose in Group 3 or remained on a low dose in Group 4. High dose was defined as an equivalent dose of hydrocortisone equal or greater to 250 mg. The primary objective of this study was resolution of angioedema, defined as discontinuation or de-escalation of steroid therapy, de-escalation of oxygen therapy, or documentation of resolution of symptoms. Secondary objectives included adjuvant angioedema treatments used, oxygen requirements over two days, incidence of intubation, hospital length of stay, ICU length of stay, and adverse effects including infection and hyperglycemia post steroid initiation.


Results: A total of 66 patients were categorized into four groups based on initial and subsequent steroid doses. The median time to angioedema resolution in the high dose to high dose group (Group 1) and the high dose to low dose group (Group 2) was 2 days. The low dose to high dose group (Group 3) had the shortest resolution time, with a median time of one day. In the low dose to low dose group (Group 4), the median time to resolution was 2.5 days. Group 1 included all patients who required intubation, accounting for 15% of the total study population. ICU length of stays was longest at 3 days in Group 1 followed by 2.5 and 1.5 days in Group 2 and 4 respectively. Additionally, patients in the higher dose regimen groups experienced higher rates of hyperglycemia and infection when compared to regimens with lower doses.


Conclusion: This study highlights the gap in current guidance for the use of corticosteroid dosing strategies for angioedema. While high dose regimens are commonly used, practitioners should assess patient specific factors due to increased risk of adverse effects with higher dosing regimens. Transitioning to lower doses may provide a safer and equally effective alternative. This area of practice calls for future research to develop standardized guidelines to optimize corticosteroid use in angioedema treatment, ensuring both efficacy and safety for patients.