Ventilatorassoziierte Pneumonien: Präventive Wirkung von ACE-Hemmern und Angiotensin-Rezeptorblockern

Background: 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). Methods: 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. Results: 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).