Critical care of patients with AIDS.
OBJECTIVE
We sought to review the clinical and ethical issues surrounding critical care for patients with the acquired immunodeficiency syndrome (AIDS).


METHODS
We reviewed published studies and abstracts dealing with the outcome of critical care for patients with AIDS, decision making about life-sustaining treatments in patients with AIDS, and infection control in the intensive care unit. We also consulted with a number of experts in the field.


METHODS
We selected outcome studies in which patients with documented AIDS or infection with the human immunodeficiency virus (HIV) were analyzed. We rejected data concerning patients with suspected or presumed AIDS and data concerning presumed cases of Pneumocystis carinii pneumonia (PCP).


RESULTS
Most AIDS patients who require critical care do so because of respiratory failure caused by PCP. Although studies early in the epidemic reported survival rates to hospital discharge of 0% to 14%, recent studies demonstrate improved survival rates of 36% to 55%. Treatment for patients with PCP and respiratory failure should include either intravenous trimethoprim-sulfa-methoxazole or pentamidine isethionate, as well as adjuvant corticosteroids. Patients with AIDS may require critical care for many other indications, including seizures, sepsis, and hypotension, or reasons unrelated to their immunodeficiency. In general, such patients have a better prognosis than those with respiratory failure.


CONCLUSIONS
The provision of critical care for PCP and respiratory failure specifically or AIDS generally cannot be considered futile. Therefore, decisions about the use of critical care should be guided by the particular clinical situation and the patient's preferences. More research is needed to elucidate the reasons for the improving survival for patients with PCP and respiratory failure and the predictors of such survival.
Wachter
R M
RM
Medical Service, San Francisco, General Hospital Medical Center, University of California 94143-0862.
Luce
J M
JM
Hopewell
P C
PC
D000163:Acquired Immunodeficiency Syndrome / Q000628:therapy*; D003422:Critical Care; D003428:Cross Infection / Q000517:prevention & control; D003657:Decision Making; D004992:Ethics, Medical; D006801:Humans; D008020:Life Support Care; D018579:Patient Selection; D011020:Pneumonia, Pneumocystis / Q000628:therapy; D040841:Resource Allocation; D012131:Respiratory Insufficiency / Q000628:therapy; D028761:Withholding Treatment