Outcome of Intensive Care in Patients with the Acquired Immunodeficiency Syndrome

Abstract

The prognosis of patients who become critically ill due to complications of the acquired immunodeficiency syndrome (AIDS) is generally believed to be poor, but no detailed studies have substantiated this impression. We performed a retrospective analysis of patients with AIDS admitted to the Medical Special Care Unit (MSCU) at Mount Sinai Medical Center in New York over a 42-month period. Of 910 patients admitted to the MSCU, 35 (4% ) had AIDS. An additional patient admitted to the pediatric intensive care unit was included in the analysis. Respiratory failure occurred in 31 patients (86% ) and was the most common problem necessitating admission. Twenty-five of these patients (69% ) had Pneumocystis carinii pneumonia. All 31 patients with respiratory failure required endotracheal intubation and mechanical ventilation, and 27 (87%) died during the same hospitalization. Pneumothorax requiring tube thoracostomy occurred in 6 of 31 patients receiving mechanical ventilatory support. Among the 4 mechanically ventilated survivors, only 2 patients remain alive. Intensive care unit intervention in patients with AIDS and respiratory failure is associated with a poor outcome and probably does not alter the ultimate course in most cases.

Outcomes of Intensive Care for Patients With Human Immunodeficiency Virus Infection

“…[14][15][16][17] During the first decade of the epidemic, about two thirds of admissions to the ICU among patients with AIDS were for respiratory failure, and roughly half of all admissions were specifically due to respiratory failure from PCP. 8,[21][22][23] Recently, in our study and others, [14][15][16][17] respiratory failure from PCP or from other causes has made up a smaller, but still significant, proportion of admissions to ICUs among patients with AIDS.…”

“…In the beginning of the epidemic, most admissions were for respiratory failure, especially that associated with PCP. 8,[21][22][23] More recently, a wider variety of indications precipitated intensive care, although respiratory failure remains the single most common indication. Since 1995, hospital or ICU mortality rates for patients with HIV or AIDS have been 28% to 51%.…”

“…Typically, even more than a decade ago, 9% to 14% of ICU admissions of patients with AIDS or HIV were for sepsis, 8,[21][22][23] and recent mortality rates were about 50%. [14][15][16][17] Another indication for intensive care in patients infected with HIV, and one that has become increasingly important, is neurologic disease.…”

Predicting mortality from HIV-associated Pneumocystis pneumonia at illness presentation: an observational cohort study

“…Pneumocystis pneumonia (PCP), however, remains the most common AIDS-defining illness in the current era, and is a frequent cause of morbidity and mortality in HIV-infected patients 2 3. In the pre-CART era, mortality from PCP ranged from 10% to 30%,4 5 6 7 8 9 with even higher mortality rates of 35–85% in patients requiring admission to an intensive care unit (ICU) 10 11 12 13 14 15 16. In comparison, few studies have examined PCP mortality in the CART era.…”

ICU admission in patients infected with the human immunodeficiency virus — a multicentre survey

“…During the 1980s, HIV-infection had a poor prognosis and high morbidity, occasionally leading to ICU admission with poor survival [1]. This led to the perception among clinicians that ICU admission in HIV was associated with a poor outcome.…”