To perform a descriptive case-study of HIV patients with PCP who develop acute respiratory failure (ARF) requiring intensive care unit (ICU) admission and to identify variables that are predictive of death in the ICU.
Case series of 19 consecutive HIV-infected patients with microbiological evidence of PCP on broncho-alveolar lavage who are admitted to the medical ICU of a 1500-bed university-affliated tertiary care hospital.
A total of 19 patients (18 males, 1 female) with mean age of 47 ± 7 years were recruited. Twelve patients (63%) required intubation and mechanical ventilation (MV) for worsening hypoxaemia for an average of 12 ± 7 days; non-invasive ventilation was attempted on one patient and failed. All the remaining 7 patients who did not require MV survived to hospital discharge, with 3 patients alive at 1-year's duration, and 4 lost to follow-up. Intensive care unit mortality for intubated patients was 66%. Patients who had a higher APACHE II score (p = 0.01), lower total leukocyte count at admission (p = 0.041), suffered from acute kidney injury (AKI) requiring renal replacement therapy (p = 0.003) or developed septic shock requiring inotropic support (p = 0.002) were likely to die in the ICU. The occurrence of pneumothorax was uncommon (N=1), despite the use of high positive end-expiratory pressure (mean 12 ± 4 cmH2O). Variables previously reported to be associated with ICU mortality such as blood oxygenation (expressed as the alveolar-arterial oxygen gradient at room air, serum albumin levels and low levels of haemoglobin were found to be not significant in our study population. No patients were receiving or started on highly-active antiretroviral therapy during the ICU stay.
Our study suggests risk factors for death from PCP-related ARF in the ICU are identifiable at or after admission. The occurrence of pneumothorax was uncommon.
The poor ICU survival rate underscores the need for earlier diagnosis of HIV to identify patients at risk for developing PCP.
Steve Yang, No Financial Disclosure Information; No Product/Research Disclosure Information