Comparing outcomes of HIV versus non-HIV patients requiring mechanical ventilation.
BACKGROUND
Mechanical ventilation (MV) is a predictor of mortality in patients infected with human immunodeficiency virus (HIV) in the intensive care unit (ICU). Patients with HIV-infections are admitted to the ICU for a variety of reasons that frequently require intubation. While survival rates for HIV-infected patients continue to improve, ICU admission rates have remained consistent.


METHODS
To observe the consequences of MV in HIV-infected patients, we conducted a retrospective chart review on patients with HIV (n=55) vs. matched HIV-negative patients (n=55) who required MV over a one-year period and compared the groups for differences in outcome and complications.


RESULTS
The HIV group had twice the number of deaths (44% vs. 22%, all-cause mortality) (P=0.01). Among the HIV-positive group, 5 of 55 patients required tracheostomy and prolonged MV, compared to 15 of 55 in the control group (9% and 27%, respectively). Successful extubation was virtually identical (47% MV vs. 50% control). Ventilator-associated pneumonia (VAP) was significantly higher among HIV-positive cases (39 of 55 HIV vs. 14 of 55 non-HIV) (P=0.05). Regression analysis revealed that hypotension, hypoalbuminemia, and fever predicted a poorer outcome. Low CD4 cell counts were strongly associated with mortality.


CONCLUSIONS
HIV-infected patients requiring MV have significantly higher mortality and VAP rates than HIV-negative patients. Since VAP is associated with a poor prognosis, discovering ways to prevent it in the HIV-infected patient may improve outcome.
Pulmonary Disease and Critical Care Medicine, University of North Carolina School of Medicine, 130 Mason Farm Rd, Chapel Hill, NC 27599, USA. drvikaspathak@gmail.com
Vikas
V
Pathak
Iliana Samara Hurtado
IS
Rendon
Shebli
S
Atrash
Vinay Prasad Rao
VP
Gagadam
Kaushik
K
Bhunia
Syam Prasad
SP
Mallampalli
Vijay
V
Vegesna
Mahesh Mani
MM
Dangal
Ronald L
RL
Ciubotaru
D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology*; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D014139:Tracheostomy / Q000706:statistics & numerical data; D014140:Tracheotomy / Q000706:statistics & numerical data