Document 0030
 DOCN  M95A0030
 TI    Intensive care for patients with AIDS: clinical and ethical issues.
 DT    9510
 AU    Wachter RM; Medical Service, San Francisco General Hospital Medical
       Center,; University of California 94143-0862, USA.
 SO    Schweiz Med Wochenschr. 1995 Jun 10;125(23):1119-22. Unique Identifier :
       AIDSLINE MED/95320542
 AB    Pneumocystis carinii pneumonia (PCP) remains a common and morbid
       infection among patients with the acquired immunodeficiency syndrome
       (AIDS). Most patients who die of PCP do so because of respiratory
       failure. The survival after intubation and mechanical ventilation for
       PCP and respiratory failure has gone through three eras: Era I
       (1981-85), when the survival rate to hospital discharge was about 10%;
       Era II (1986-88), when the hospital survival rate rose to about 40%; and
       Era III (1989-present), when the hospital survival rate fell again to
       about 25%. Patients with CD4 counts of less than 50, patients who
       develop pneumothoraces while intubated, and patients spending more than
       2 weeks in the ICU receiving mechanical ventilation appear to have very
       poor (< 10% survival) prognoses. As the survival rate has fallen in
       recent years, so too has the cost-effectiveness of ICU care for patients
       with severe PCP. It now costs about $200,000 (U.S.) to save a year of
       life through the use of the ICU in PCP, a relatively cost-ineffective
       intervention. Our present approach is to provide patients information
       about prognosis and options and allow them to make an informed choice
       about whether they would like ICU care should the medical need arise.
       Whether the high costs and low cost-effectiveness of intensive care
       should and will be factored into this decision are questions of great
       clinical and ethical importance for the future.
 DE    Acquired Immunodeficiency Syndrome/IMMUNOLOGY/MORTALITY/*THERAPY
       AIDS-Related Opportunistic Infections/THERAPY  CD4 Lymphocyte Count
       *Ethics, Medical  Health Care Costs  Human  *Intensive Care  Pneumonia,
       Pneumocystis carinii/THERAPY  Prognosis  Respiration, Artificial
       JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).