The following is a summary of “Association between the use of angiotensin-converting enzyme inhibitors /angiotensin receptor blockers and the development of ventilator-associated pneumonia in the intensive care unit: a retrospective cohort study,” published in the November 2024 issue of Pulmonology by Cai et al. 

Researchers conducted a retrospective study to examine the linkage between treatment of patients with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and the risk of ventilator-associated pneumonia (VAP) receiving mechanical ventilation (MV) in the intensive care unit (ICU).  

They extracted data from the Medical Information Mart for Intensive Care IV database to examine the association between ACEI, ARB use and VAP risk, VAP diagnoses were identified using the international classification of disease codes. Univariate and multivariable logistic regression analyses were conducted to assess this relationship. The subgroup analyses evaluated the impact of comorbidities (acute kidney injury [AKI], renal failure, diabetes, hypertension, and sepsis), the simplified acute physiology score II (SAPS II), and the use of vasopressors and antibiotics. The odds ratios (ORs) with 95% CIs were calculated for evaluation.  

The results showed that among 8,888 patients, 897 (10.09%) developed VAP. The analysis indicated that patients receiving ACEI or ARB therapy had a lower risk of VAP [OR]: 0.79, 95% [CI]: 0.62–0.99, P = 0.047). Subgroup analyses found that the protective effect was present in patients with AKI (OR: 0.70, 95% CI: 0.52–0.94, P = 0.020), renal failure (OR: 0.14, 95% CI: 0.02–0.84, P = 0.032), and diabetes (OR: 0.64, 95% CI: 0.43–0.94, P = 0.024), as well as those receiving vasopressors (OR: 0.67, 95% CI: 0.49–0.92, P = 0.012) and antibiotics (OR: 0.74, 95% CI: 0.57–0.96, P = 0.021). No significant difference in VAP development was found between patients treated with ACEI vs ARB (OR: 0.84, 95% CI: 0.49–1.47, P = 0.547).  

Investigators concluded that ACEIs and ARBs might reduce the risk of VAP, especially in patients with specific comorbidities, such as those on vasopressor and antibiotic therapy, and could be considered in the overall treatment plan. 

Source: bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-024-03386-y