Pneumocystis carinii pneumonia requiring intensive care management: survival and prognostic study in 110 patients with human immunodeficiency virus.

Abstract

OBJECTIVE:

To perform a descriptive study of patients with acute respiratory failure secondary to acquired immunodeficiency syndrome-related Pneumocystis carinii pneumonia and to identify variables that are predictive of death within 3 months.

DESIGN:

Case series study.

SETTING:

Infectious disease intensive care unit (ICU) in a university hospital.

PATIENTS:

Detailed clinical, laboratory, and ventilatory data were collected prospectively within 48 hrs of admission and during the ICU stay in 110 consecutive human immunodeficiency virus-infected patients requiring ICU management with or without mechanical ventilation for P. carinii pneumonia-related acute respiratory failure.

MEASUREMENTS AND MAIN RESULTS:

Continuous positive airway pressure was used initially in 66 (60%) patients. Among the 34 patients (31%) who required mechanical ventilation, including 12 at admission and 22 after failure of continuous positive airway pressure, 76% died. The 3-month mortality rate after ICU admission was estimated at 34.6% (95% confidence interval [CI], 25%-44%). The 1-yr survival rate was estimated at 47% (95% CI, 36%-58%). With successive multiple logistic regression models analyzing the relative prognostic importance of baseline clinical and laboratory tests variables, ventilation variables, and events in the ICU, only delayed mechanical ventilation after 3 days (odd ratio [OR], 6.7; 95% CI, 1.9-23.9), duration of mechanical ventilation of > or = 5 days (OR, 2.8; 95% CI, 1.1-6.9), nosocomial infection (OR, 5.2; 95% CI, 2.1-12.9), and pneumothorax (OR, 5; 95% CI, 1.7-14.7) were predictive of death within 3 months of ICU admission. Among patients with delayed mechanical ventilation on day 3 or later and with a pneumothorax associated or not associated with a nosocomial infection, the predicted probability of 3-month death was close to 100%.

CONCLUSIONS:

Our data suggest that the most significant predictive factors of death were identifiable during the course of P. carinii pneumonia-related acute respiratory failure rather than at admission and can help in bedside decisions to withdraw intensive care support in such patients.

• Authors: J P Bédos, J L Dumoulin, B Gachot, B Veber, M Wolff, B Régnier, S Chevret
• Journal: Critical care medicine (Crit Care Med) Vol. 27 Issue 6 Pg. 1109-15 (Jun 1999) ISSN: 0090-3493 [Print] United States
• PMID: 10397214 (Publication Type: Journal Article)

Topics

• AIDS-Related Opportunistic Infections (complications, mortality, therapy)
• APACHE
• Acute Disease
• Adult
• Critical Care (methods)
• Female
• HIV Infections (complications)
• Humans
• Intensive Care Units
• Logistic Models
• Male
• Pneumonia, Pneumocystis (complications, mortality, therapy)
• Positive-Pressure Respiration
• Predictive Value of Tests
• Prognosis
• Prospective Studies
• Respiratory Insufficiency (etiology, mortality, therapy)
• Risk Factors
• Survival Rate