Abstract | OBJECTIVE: DESIGN: Case series study. SETTING: 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
|