Department of Critical Care Medicine, People's Hospital, Yanliang District, 9 Kangfu Lane, Xi'an City, Shaanxi Province, 710089, People's Republic of China.
Department of Neurology, People's Hospital, Yanliang District, 9 Kangfu Lane, Xi'an City, Shaanxi Province, 710089, People's Republic of China.
BMC Pulm Med. 2024 Nov 21;24(1):578. doi: 10.1186/s12890-024-03386-y.
This study was to examine the association between treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and the risk of developing ventilator-associated pneumonia (VAP) among patients receiving mechanical ventilation (MV) in the intensive care unit (ICU).
Utilizing a retrospective cohort approach, the data were extracted from the Medical Information Mart for Intensive Care IV database. VAP diagnoses were ascertained through the international classification of disease codes recorded in the database. Both univariate and multivariable logistic regression analyses were conducted to assess the association between ACEI or ARB use and VAP. Subgroup analyses were performed to evaluate the impact of comorbidities (AKI, renal failure, diabetes, hypertension, and sepsis), simplified acute physiology score II (SAPS II), as well as the use of vasopressors and antibiotics on this association. Odds ratios (ORs) with 95% confidence intervals (CIs) were used as the evaluation metrics.
The study comprised 8,888 patients, with 897 (10.09%) experiencing VAP. The analysis revealed that patients on ACEI or ARB therapy had a lower risk of developing VAP (OR: 0.79, 95% CI: 0.62-0.99, P = 0.047). Subgroup analyses revealed that the protective effect was observed 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 in 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 observed between patients treated with ACEI versus ARB (OR: 0.84, 95% CI: 0.49-1.47, P = 0.547).
This study's findings suggest a substantial association between the use of ACEIs or ARBs and reduced development of VAP, particularly among patients with specific comorbidities and those on vasopressor and antibiotic therapy. This study may educate the ICU team on the potential benefits of ACEIs and ARBs in preventing VAP, emphasizing the importance of considering these medications in the overall treatment plan.
本研究旨在探讨血管紧张素转换酶抑制剂（ACEIs）或血管紧张素受体阻滞剂（ARBs）治疗与重症监护病房（ICU）接受机械通气（MV）患者发生呼吸机相关性肺炎（VAP）风险之间的关系。
本研究采用回顾性队列研究方法，从医疗信息集市-重症监护 IV 数据库中提取数据。VAP 的诊断通过数据库中记录的国际疾病分类代码确定。采用单变量和多变量逻辑回归分析评估 ACEI 或 ARB 使用与 VAP 之间的关联。进行亚组分析以评估合并症（急性肾损伤、肾衰竭、糖尿病、高血压和败血症）、简化急性生理学评分 II（SAPS II）以及血管加压素和抗生素使用对这种关联的影响。使用比值比（OR）和 95%置信区间（CI）作为评估指标。
该研究共纳入 8888 例患者，其中 897 例（10.09%）发生 VAP。分析显示，接受 ACEI 或 ARB 治疗的患者发生 VAP 的风险较低（OR：0.79，95%CI：0.62-0.99，P=0.047）。亚组分析显示，在合并急性肾损伤（OR：0.70，95%CI：0.52-0.94，P=0.020）、肾衰竭（OR：0.14，95%CI：0.02-0.84，P=0.032）和糖尿病（OR：0.64，95%CI：0.43-0.94，P=0.024）的患者、接受血管加压素（OR：0.67，95%CI：0.49-0.92，P=0.012）和抗生素（OR：0.74，95%CI：0.57-0.96，P=0.021）治疗的患者中，这种保护作用更为明显。在 ACEI 与 ARB 治疗的患者中，VAP 的发生无显著差异（OR：0.84，95%CI：0.49-1.47，P=0.547）。
本研究结果表明，ACEIs 或 ARBs 的使用与 VAP 的发生显著相关，尤其是在有特定合并症以及接受血管加压素和抗生素治疗的患者中。本研究可以为 ICU 团队提供 ACEIs 和 ARBs 预防 VAP 的潜在益处方面的教育，强调在整体治疗计划中考虑这些药物的重要性。
