Document 0412
 DOCN  M9550412
 TI    Outcome of intensive care in patients with HIV infection.
 DT    9505
 AU    De Palo VA; Millstein BH; Mayo PH; Salzman SH; Rosen MJ; Division of
       Pulmonary and Critical Care Medicine, Beth Israel; Medical Center,
       Albert Einstein College of Medicine, New York.
 SO    Chest. 1995 Feb;107(2):506-10. Unique Identifier : AIDSLINE MED/95145063
 AB    OBJECTIVES: To examine ICU admission rates and diagnoses of patients
       with HIV infection and to determine the outcomes of different critical
       illnesses. DESIGN: Consecutive enrollment of patients admitted to the
       ICU with confirmed HIV infection or an AIDS-defining diagnosis. SETTING:
       Medical ICU of an urban teaching hospital. PATIENTS: 65 adult patients
       with documented HIV infection or AIDS-defining disorder. INTERVENTIONS:
       Standard care. RESULTS: In 1 year, there were 1,550 hospital admissions
       for patients with HIV infection, and 65 (4.2%) were admitted to the ICU.
       The mortality rate of patients admitted to the ICU was 51%; 35 (54%)
       were admitted with respiratory failure, 22 of whom had Pneumocystis
       carinii pneumonia (PCP). Sixteen patients with PCP required mechanical
       ventilation, and 13 (81%) died despite treatment with adjunctive
       corticosteroids. Other causes of respiratory failure included bacterial
       pneumonia, pulmonary tuberculosis, adult respiratory distress syndrome,
       and pulmonary Kaposi's sarcoma. Overall, 22 of 35 (63%) patients with
       respiratory failure died in the hospital. Thirty patients (46%) were
       admitted because of sepsis, neurologic disease, congestive heart
       failure, hypotension, or drug overdose. These patients had a mortality
       rate of 37%. Prior antiretroviral and anti-Pneumocystis prophylaxis did
       not influence outcome, but a body weight of 10% or more below ideal at
       the time of admission predicted poor survival. CONCLUSION: There is a
       diverse range of indications for critical care in patients with HIV
       infection. Although respiratory failure due to PCP was the most common
       reason for admission to the ICU, it accounted for only 34% of the cases.
       The prognosis of PCP in patients who require mechanical ventilation
       despite adjunctive corticosteroid treatment is poor.
 DE    Adult  CD4 Lymphocyte Count  Female  Human  HIV
       Infections/COMPLICATIONS/IMMUNOLOGY/MORTALITY/*THERAPY  *Intensive Care
       Units  Male  Middle Age  Prognosis  Respiration, Artificial  Respiratory
       Insufficiency/ETIOLOGY/THERAPY  JOURNAL ARTICLE

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