Improvements in outcomes of acute respiratory failure for patients with human immunodeficiency virus-related Pneumocystis carinii pneumonia.
In the early 1990s, hospital survival among patients with human immunodeficiency virus (HIV)-related Pneumocystis carinii pneumonia (PCP) and respiratory failure was poor, approximately 20%. We examined ICU use and outcomes for patients with acute respiratory failure from PCP from 1995 to 1997. We conducted a retrospective medical record review using a random sample of 71 hospitals in seven regions of the United States. Among 1,660 patients with confirmed or presumed PCP, 155 (9%) received mechanical ventilation for respiratory failure. Factors that predicted use of mechanical ventilation, independent of severity of illness on hospital admission, included African-American ethnicity and geographic location (p </= 0.002). Hospital survival for patients receiving mechanical ventilation was 38% (95% CI 30, 46). Controlling for severity of illness, patients who were on PCP prophylaxis prior to developing PCP were less likely to survive to hospital discharge (p </= 0.02). There were no significant differences in hospital survival regardless of whether patients had received less than or more than 5 d of PCP treatment prior to respiratory failure (39 versus 29%; p = 0.5). In conclusion, from 1995 to 1997, hospital survival after PCP requiring mechanical ventilation was approximately 40%. Physicians caring for patients with severe HIV-related PCP should be aware of the improvements in outcomes for this disease before making recommendations about withholding or withdrawing ventilatory support for respiratory failure.
Curtis
J R
JR
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA.
Yarnold
P R
PR
Schwartz
D N
DN
Weinstein
R A
RA
Bennett
C L
CL
D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000208:Acute Disease; D005260:Female; D006801:Humans; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000150:complications* / Q000628:therapy; D011379:Prognosis; D011897:Random Allocation; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome