DOI: 10.1097/01.ccm.0000458199.59466.19

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Issn Print: 0090-3493

Publication Date: 2014/12/01


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702: ANGIOTENSIN-CONVERTING ENZYME INHIBITOR (ACEI) INDUCED ANGIOEDEMA IN THE INTENSIVE CARE UNIT (ICU)

Laura Baumgartner; Scott Chapman

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Author Information: Touro University California College of Pharmacy, San Francisco, CA

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Learning Objectives: Angioedema is a rare, but serious adverse effect associated with ACEIs. There is a lack of literature surrounding the characteristics and management of severe cases requiring ICU level care. Corticosteroids, epinephrine, and/or histamine blockers are often used to manage these patients despite limited reported efficacy. The purpose of this study was to identify predictors of mechanical ventilation in patients suffering from ACEI induced angioedema and describe treatment strategies used in the emergency department (ED) and ICU.
Methods: A retrospective cohort study that included all adult patients suspected of having ACEI induced angioedema who were admitted to the ICU from 2008–2012. Predictors of mechanical ventilation analyzed were age, sex, race, comorbidities, tobacco use, number of sites of edema, location of edema, duration and dose of ACEI used, and treatment course in the ED. Correlation of corticosteroid usage (analyzed in mg/day) and decreased time to extubation and ICU length of stay was performed using a logistic regression analysis.
Results: Forty-five patients were evaluated; 22 (49%) of whom required mechanical ventilation. Non-Caucasian patients (p=0.04), and those with COPD (p=0.04), asthma (p=0.02), > 2 sites of edema (p=0.04), or pharyngeal (p=0.02) or soft palate edema (p=0.02) at ED presentation were significantly more likely to require mechanical ventilation. Sex, tobacco use, and dose, duration, and type of ACEI had no impact on need for intubation. Treatment in the ED with corticosteroids, epinephrine, and/or histamine blockers did not significantly impact a patient’s need for intubation, and corticosteroid treatment in the ICU had no significant reduction in time to extubation or ICU length of stay.
Conclusions: This is the first study that has compared patient characteristics and treatment approaches of patients suffering from ACEI induced angioedema in the ICU. Predictors of tracheal intubation included non-Caucasian races, COPD or asthma, > 2 sites of edema, and pharyngeal or soft palate edema. Use of corticosteroids (mg/day) did not improve patient outcomes.

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