Angiotensin-converting Enzyme Inhibitor Angioedema Requiring Admission to an Intensive Care Unit

Area of Science:

• Cardiology
• Pulmonology
• Pharmacology

Background:

• Angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed for hypertension and heart failure.
• Angioedema is a rare but potentially life-threatening side effect of ACE inhibitors.
• Management of ACE inhibitor-induced angioedema, particularly in intensive care settings, requires understanding of risk factors and predictors of severity.

Purpose of the Study:

• To review cases of ACE inhibitor-induced angioedema admitted to the intensive care unit.
• To identify patient demographics, clinical characteristics, and outcomes.
• To determine predictors of respiratory compromise and need for ventilatory support.

Main Methods:

• Retrospective review of 50 patients with ACE inhibitor angioedema admitted to the ICU between 1998 and 2011.
• Analysis of patient demographics, ACE inhibitor use duration, clinical presentation, and interventions.
• Logistic regression analysis to identify factors associated with the need for ventilatory support.

Main Results:

• All 50 patients were male, with a mean age of 62.8 years; 76% were African American.
• Thirty percent (15/50) required ventilatory support, and 4% (2/50) required tracheostomy.
• Dyspnea, tongue involvement, and hypercapnia (PaCO2 > 45.2 mmHg) were significant predictors of the need for ventilatory support (P < .01).
• Over half (56%) of patients had used ACE inhibitors for more than one year prior to angioedema onset.

Conclusions:

• ACE inhibitor-associated angioedema can manifest even after prolonged medication use.
• Approximately one-third of ICU admissions for ACE inhibitor angioedema necessitate ventilatory support.
• Early identification of dyspnea and tongue involvement is crucial for predicting the need for respiratory support in these patients.