Document Detail


Improvements in outcomes of acute respiratory failure for patients with human immunodeficiency virus-related Pneumocystis carinii pneumonia.
MedLine Citation:
PMID:  10934059     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In the early 1990s, hospital survival among patients with human immunodeficiency virus (HIV)-related Pneumocystis carinii pneumonia (PCP) and respiratory failure was poor, approximately 20%. We examined ICU use and outcomes for patients with acute respiratory failure from PCP from 1995 to 1997. We conducted a retrospective medical record review using a random sample of 71 hospitals in seven regions of the United States. Among 1,660 patients with confirmed or presumed PCP, 155 (9%) received mechanical ventilation for respiratory failure. Factors that predicted use of mechanical ventilation, independent of severity of illness on hospital admission, included African-American ethnicity and geographic location (p </= 0.002). Hospital survival for patients receiving mechanical ventilation was 38% (95% CI 30, 46). Controlling for severity of illness, patients who were on PCP prophylaxis prior to developing PCP were less likely to survive to hospital discharge (p </= 0.02). There were no significant differences in hospital survival regardless of whether patients had received less than or more than 5 d of PCP treatment prior to respiratory failure (39 versus 29%; p = 0.5). In conclusion, from 1995 to 1997, hospital survival after PCP requiring mechanical ventilation was approximately 40%. Physicians caring for patients with severe HIV-related PCP should be aware of the improvements in outcomes for this disease before making recommendations about withholding or withdrawing ventilatory support for respiratory failure.
Authors:
J R Curtis; P R Yarnold; D N Schwartz; R A Weinstein; C L Bennett
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  162     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2000 Aug 
Date Detail:
Created Date:  2000-09-15     Completed Date:  2000-09-15     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  393-8     Citation Subset:  AIM; IM; X    
Affiliation:
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA.
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MeSH Terms
Descriptor/Qualifier:
AIDS-Related Opportunistic Infections / complications*
Acute Disease
Female
Humans
Male
Pneumonia, Pneumocystis / complications*,  therapy
Prognosis
Random Allocation
Respiration, Artificial
Respiratory Insufficiency / etiology,  mortality*,  therapy
Retrospective Studies
Treatment Outcome
Grant Support
ID/Acronym/Agency:
5RO1DA10628-02/DA/NIDA NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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