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

Am J Med. 2015 Jul;128(7):785-9. doi: 10.1016/j.amjmed.2015.02.006. Epub 2015 Mar 10.

Abstract

Objective: The purpose of this study was to review consecutive cases of angiotensin-converting enzyme (ACE) inhibitor angioedema admitted to an intensive care unit.

Methods: Fifty subjects with ACE-inhibitor angioedema admitted from 1998-2011 were reviewed.

Results: All 50 subjects were men, 62.8 ± 8.4 years of age, 76% African Americans. Fifteen (30%) required ventilatory support and 2 (4%) required tracheostomy. Over half (56%) had taken ACE inhibitors for over a year. Logistic regression identified dyspnea and tongue involvement with the need for ventilatory support (P < .01). Hypercapnia (PaCO2 = 45.2 ± 6.7; P = 0.046) also identified patients needing ventilatory support.

Conclusions: Ventilatory support was provided for about one-third of those with ACE inhibitor-associated angioedema. Angioedema can occur even after extended use. Dyspnea and tongue involvement identified patients requiring ventilatory support.

Keywords: Angioedema; Angiotensin-converting enzyme inhibitor; Respiratory failure.

MeSH terms

  • Age Distribution
  • Aged
  • Angioedema / chemically induced*
  • Angioedema / mortality
  • Angioedema / therapy*
  • Angiotensin-Converting Enzyme Inhibitors / adverse effects*
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Cohort Studies
  • Confidence Intervals
  • Critical Care / methods
  • Critical Care / statistics & numerical data
  • Follow-Up Studies
  • Hospital Mortality*
  • Humans
  • Incidence
  • Intensive Care Units / statistics & numerical data*
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Patient Admission / statistics & numerical data
  • Respiration, Artificial / methods
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Sex Distribution
  • Survival Rate
  • Tracheostomy / methods

Substances

  • Angiotensin-Converting Enzyme Inhibitors