Active Tuberculosis in the Medical Intensive Care Unit

Frame, Richard N.; Johnson, Matthew T.; Eichenhorn, Michael S.; Bower, George C.; Popovich, John

doi:10.1097/00003246-198711000-00005

Cited by 55 publications

(58 citation statements)

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“…However, the mortality rate of the current study was similar to other studies, including those with HIV patients [4][5][6][7]. It is worth noting that the early mortality rate from TB in HIVpositive patients was not different from that of HIV-negative patients [28].…”

Section: Discussionsupporting

confidence: 84%

“…Despite advances in chemotherapy, cases of pulmonary TB and TB-related critical illness increased dramatically over the last few decades. In-hospital mortality rate remains high at y60%, for patients with active pulmonary TB and respiratory failure [4][5][6][7][8][9][10]. This is twice as high as the mortality rate of patients with pneumonia requiring mechanical ventilation [4,11,12].…”

mentioning

confidence: 99%

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Patient mortality of active pulmonary tuberculosis requiring mechanical ventilation

Lee¹,

Jerng²,

Chang³

et al. 2003

Eur Respir J

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Mortality remains high among patients with pulmonary tuberculosis requiring mechanical ventilation (TBMV). This study was carried out to establish the mortality rates of TBMV and to identify factors that contribute to in-hospital mortality.From January 1996-April 2001, there were 825 patients with active pulmonary tuberculosis at the National Taiwan University Hospital, Taipei, Taiwan. Of these, 41 suffered acute respiratory failure and required mechanical ventilation in the intensive care unit (ICU). Of these 41 patients, 38 were followed up for 180 days. In-hospital deaths were documented in the medical records and all possible parameters contributing to mortality were collected.Of the 41 patients, 27 died in the hospital and 14 were discharged alive (in-hospital mortality rate 65.9%), with (mean¡SD) 40.7¡35.4 admission days before death. Of the 27 that died, 25 died during ICU admission and two died after being transferred to the ward. The mortality rate for the 180-day monitoring period was 79%. Factors contributing to in-hospital mortality included consolidations on chest radiographs and multiple organ failure.The mortality rate in the patients with pulmonary tuberculosis requiring mechanical ventilation is very high, with two factors affecting in-hospital mortality. These factors were multiple organ failure and consolidation on chest radiographs. In 2000, an estimated 8 million people were infected and 2 million people died of tuberculosis (TB) worldwide [1][2][3]. Despite advances in chemotherapy, cases of pulmonary TB and TB-related critical illness increased dramatically over the last few decades. In-hospital mortality rate remains high at y60%, for patients with active pulmonary TB and respiratory failure [4][5][6][7][8][9][10]. This is twice as high as the mortality rate of patients with pneumonia requiring mechanical ventilation [4,11,12].Delays in the diagnosis and treatment of pulmonary TB have been recognised as the main causes of death [2,4,8,[13][14][15][16]. Several studies have sought to reduce these delays by identifying factors that lead to a high index of suspicion [4,8,[13][14][15][17][18][19][20]. The reasons for delays in diagnosis include the failure to perform appropriate diagnostic investigation and the misinterpretation of radiological or clinical manifestations as malignancy, pneumonia or other conditions [4,8,[13][14][15][17][18][19][20][21][22].Reports of active pulmonary TB with acute respiratory failure are not scarce, but few focus on mechanically ventilated patients. Such patients have a higher mortality rate than patients who do not need mechanical ventilation [4-6, 8, 10]. However, w50% of the patients included in these previous studies were positive for human immunodeficiency virus (HIV) infection. Hence, conclusions derived from these studies may not apply to HIV-negative patients.Therefore, the authors conducted a retrospective study with three objectives in relation to active pulmonary TB patients requiring support by mechanical ventilation (TBMV). These object...

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Section: Discussionsupporting

confidence: 84%

mentioning

confidence: 99%

Patient mortality of active pulmonary tuberculosis requiring mechanical ventilation

Lee¹,

Jerng²,

Chang³

et al. 2003

Eur Respir J

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“…The findings of the present study, with a mean age of 48 yrs in ICU-treated TB patients, suggest that newly acquired TB infections may present a more severe cause of the disease. However, the average age of patients in other studies ranged between 41 [9] and 59 yrs [2]. A further sex-related finding was that severe TB affected more often male patients, which is in agreement with other studies.…”

Section: Tuberculosis and Intensive Care R Erbes Et Alsupporting

confidence: 89%

“…Similar factors influencing the course of most severe TB were reported by other studies. FRAME et al [2] reported an in-hospital mortality rate of 67% for patients with TB requiring intensive care; ,70% of the patients in this study developed acute respiratory failure and the mortality rate increased to 83%; factors identified as contributing to respiratory failure were Gram-negative pneumonia and/or sepsis, COPD, prior anti-TB medication with non-compliance and malignancy. With a 1.5% incidence of acute respiratory failure in patients hospitalised with pulmonary TB, LEVY et al…”

Section: Tuberculosis and Intensive Care R Erbes Et Almentioning

confidence: 46%

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Characteristics and outcome of patients with active pulmonary tuberculosis requiring intensive care

Erbes

Oettel²,

Raffenberg³

et al. 2006

European Respiratory Journal

105

131

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Severe tuberculosis (TB) requiring intensive care unit (ICU) care is rare but commonly known to be of markedly bad prognosis. The present study aimed to describe this condition and to determine the mortality rate and risk factors associated with mortality.Patients with confirmed TB admitted to ICU between 1990 and 2001 were retrospectively identified and enrolled. Clinical, radiological and bacteriological data at admission and during hospital stay were recorded. A multivariate analysis was performed to identify the predictive factors for mortality.A total of 58 TB patients (12 females, mean age 48 yrs) admitted to ICU were included. Mean Acute Physiology and Chronic Health Evaluation (APACHE) II score at admission was 13.1¡5.6 and 22 of 58 (37.9%) patients required mechanical ventilation. The in-hospital mortality was 15 of 58 (25.9%); 13 (22.4%) patients died in the ICU. The mean survival of patients who died was 53.6 days (range 1-229), with 50% of the patients dying within the first 32 days. The factors independently associated with mortality were: acute renal failure, need for mechanical ventilation, chronic pancreatitis, sepsis, acute respiratory distress syndrome, and nosocomial pneumonia.These data indicate a high mortality of patients with tuberculosis requiring intensive care unit care and identifies new independently associated risk factors.

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Tuberculosis in the Intensive Care Unit

Feldman

2005

Tropical and Parasitic Infections in the Intensive Care Unit

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Active Tuberculosis in the Medical Intensive Care Unit

Cited by 55 publications

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Patient mortality of active pulmonary tuberculosis requiring mechanical ventilation

Patient mortality of active pulmonary tuberculosis requiring mechanical ventilation

Characteristics and outcome of patients with active pulmonary tuberculosis requiring intensive care

Tuberculosis in the Intensive Care Unit

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