title: The role of tracheostomy in acquired immunodeficiency syndrome.
abstract: BACKGROUND
  Tracheostomy tube (TT) insertion for respiratory failure in patients with acquired immunodeficiency syndrome has been associated with an early mortality rate of 100%. We have reviewed our experience with tracheostomy to determine if there is a role for this procedure among certain subgroups.
  
  
  METHODS
  A retrospective review was conducted of 47 patients diagnosed with acquired immunodeficiency syndrome who underwent tracheostomy from 1988 to 1995. Patients were divided into three groups based on indications for tracheostomy: group 1, Pneumocystis carinii pneumonia (PCP); group 2, non-PCP pneumonia; and group 3, others (including neurosyphilis, endocarditis, and trauma).
  
  
  RESULTS
  All groups were similar with regard to demographic details and laboratory values (mean age, 38 +/- 1.4 years; 95% male; CD4 count = 21.8 +/- 3.6 cells/microL). In the vast majority of cases the decision to place a TT was elective. Forty-three percent of all patients had signed do not resuscitate orders before endotracheal tube intubation. The mean time from endotracheal tube to TT insertion was 14.1 +/- 1.6 days. Early mortality after TT placement was dismal (91%) for group 1 patients but significantly better (47%) in group 2 patients (p = 0.04). Early mortality usually occurred within 3 weeks of TT placement (range, 1 to 54 days). The cause of pneumonia (PCP versus non-PCP) was the only statistically significant variable in predicting outcome. For those who survived to TT removal (26%), the average time to removal of TT was 67 +/- 11 days. Long-term survival was noted in 8 group 2 patients (mean, 584 days) and in 2 group 1 patients (450 days).
  
  
  CONCLUSIONS
  Outcome after tracheostomy in patients with AIDS is generally poor. Patients with PCP should not undergo TT placement; however, patients with non-PCP pneumonia have a reasonable expected survival and should undergo the operation.
authors.affiliation: St. Vincent's Hospital and Medical Center, New York Medical College, New York, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Flum
authors.forename: O S
authors.initials: OS
authors.lastname: Bholat
authors.forename: M K
authors.initials: MK
authors.lastname: Wallack
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000401:mortality / Q000601:surgery*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000401:mortality; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011020:Pneumonia, Pneumocystis / Q000401:mortality / Q000601:surgery; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D014139:Tracheostomy