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

• Published in: The American journal of medicine Vol. 128; no. 7; pp. 785 - 789
• Main Authors: Soo Hoo, Guy W., Lin, Henry K., Junaid, Imran, Klaustermeyer, William B.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2015; Elsevier Sequoia S.A
• Subjects: ACE inhibitors; Age Distribution; Aged; Angioedema; Angioedema - chemically induced; Angioedema - mortality; Angioedema - therapy; Angiotensin-converting enzyme inhibitor; Angiotensin-Converting Enzyme Inhibitors - adverse effects; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Clinical outcomes; Cohort Studies; Confidence Intervals; Critical Care - methods; Critical Care - statistics & numerical data; Enzymes; Follow-Up Studies; Hospital Mortality; Humans; Incidence; Intensive care; Intensive Care Units - utilization; Internal Medicine; Logistic Models; Male; Middle Aged; Odds Ratio; Patient Admission - statistics & numerical data; Respiration, Artificial - methods; Respiratory diseases; Respiratory failure; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sex Distribution; Survival Rate; Tracheostomy - methods; Respiratory failure; Angiotensin-converting enzyme inhibitor; Angioedema
• ISSN: 0002-9343; 1555-7162; 1555-7162
• DOI: 10.1016/j.amjmed.2015.02.006

The purpose of this study was to review consecutive cases of angiotensin-converting enzyme (ACE) inhibitor angioedema admitted to an intensive care unit. Fifty subjects with ACE-inhibitor angioedema admitted from 1998-2011 were reviewed. 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. 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.