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

• Published in: Critical care medicine Vol. 27; no. 6; p. 1109
• Main Authors: Bédos, J P, Dumoulin, J L, Gachot, B, Veber, B, Wolff, M, Régnier, B, Chevret, S
• Format: Journal Article
• Language: English
• Published: United States 01.06.1999
• Subjects: Acute Disease; Adult; AIDS-Related Opportunistic Infections - complications; AIDS-Related Opportunistic Infections - mortality; AIDS-Related Opportunistic Infections - therapy; APACHE; Critical Care - methods; Female; HIV Infections - complications; Humans; Intensive Care Units; Logistic Models; Male; Pneumonia, Pneumocystis - complications; Pneumonia, Pneumocystis - mortality; Pneumonia, Pneumocystis - therapy; Positive-Pressure Respiration; Predictive Value of Tests; Prognosis; Prospective Studies; Respiratory Insufficiency - etiology; Respiratory Insufficiency - mortality; Respiratory Insufficiency - therapy; Risk Factors; Survival Rate
• ISSN: 0090-3493
• DOI: 10.1097/00003246-199906000-00030

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. Case series study. Infectious disease intensive care unit (ICU) in a university hospital. 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. 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%. 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.