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


METHODS
Case series study.


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


METHODS
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.


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.
Bédos
J P
JP
Service de Réanimation des Maladies Infectieuses, Groupe Hospitalier Bichat-Claude Bernard, Paris, France.
Dumoulin
J L
JL
Gachot
B
B
Veber
B
B
Wolff
M
M
Régnier
B
B
Chevret
S
S
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000401:mortality / Q000628:therapy*; D018806:APACHE; D000208:Acute Disease; D000328:Adult; D003422:Critical Care / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011175:Positive-Pressure Respiration; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D012307:Risk Factors; D015996:Survival Rate