| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
1 From the Canadian HIV Trials Network, BC Centre for Excellence in HIV/AIDS and AIDS Research Programme, St. Paul's Hospital/University of British Columbia, Vancouver, Canada
2 Program of Critical Care St. Paul's Hospital/University of British Columbia, Vancouver, Canada
3 From the Respiratory Division, Department of Medicine, St. Paul's Hospital, Vancouver, Canada
4 From the Canadian HIV Trials Network, BC Centre for Excellence in HIV/AIDS and AIDS Research Programme, St. Paul's Hospital/University of British Columbia, Vancouver; and the Department of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
5 From the Canadian HIV Trials Network, BC Centre for Excellence in HIV/AIDS and AIDS Research Programme, St. Paul's Hospital/University of British Columbia, Vancouver; and the Respiratory Division, Department of Medicine, St. Paul's Hospital, Vancouver; and the Department of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
Objective: To describe changes in incidence and outcome of acute respiratory failure (ARF) due to AIDS-related Pneumocystis carinii pneumonia (PCP) at a tertiary care center over the 4-year period starting April 1, 1987 with reference to previously reported data from the preceding 6 years.
Methods: All patients admitted to St. Paul's hospital with a diagnosis of AIDS-related PCP during the study period were reviewed with regard to diagnostic, clinical, therapeutic, and outcome variables.
Results: A total of 456 episodes of PCP were diagnosed during the study period. These were compared against 127 cases diagnosed between 1981 and 1987. The frequency of hospitalization for PCP decreased to 78% in 1987 to 1991 from 100% in 1981 to 1987 (p
0.001). A similar decreasing trend was observed with regard to the incidence of PCP-related ARF that declined from 21% in 1981 to 1987 to 9% in 1987 to 1991 (p=0.009). Despite this, overall PCP-related mortality remained stable at 12% in 1981 to 1987 and 9% in 1987 to 1991 (p=0.26). The proportion of patients with PCP-related ARF who received mechanical ventilation decreased from 89% in 1981 to 1987 to 64% in 1987 to 1991 (p<0.001). Despite this, the case fatality rate among mechanically ventilated patients increased from 50% in 1981 to 1987 to 89% in 1987 to 1991 (p=0.003). These changes were associated with a significant change in the pattern of use of corticosteroids as adjunctive therapy for AIDS-related PCP. In 1985 to 1986, nearly 100% of patients admitted to the ICU received corticosteroids only after admission to the ICU, following the development of ARF. In contrast, in 1989 to 1990, 50% of patients were admitted to the ICU already receiving systemic corticosteroids. The rise in the proportion of patients receiving corticosteroids prior to ICU admission between these two intervals was statistically significant (p= 0.017).
Conclusion: Our data show a decreasing frequency but a worsening mortality of ARF secondary to AIDS-related PCP. We conclude that ARF secondary to AIDS-related PCP developing despite maximal therapy, including adjunctive corticosteroids, carries a dismal prognosis.
Key Words: AIDS • corticosteroids • ICU • PCP • prognosis • respiratory failure • survival
Submitted on January 20, 1994
Accepted on June 1, 2007
This article has been cited by other articles:
|
|
 |
|
  R F Miller, E Allen, A Copas, M Singer, and S G Edwards Improved survival for HIV infected patients with severe Pneumocystis jirovecii pneumonia is independent of highly active antiretroviral therapy Thorax, August 1, 2006; 61(8): 716 - 721. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. S. Gilmartin and H. Koziel Pneumocystis Carinii Pneumonia in Adult Non-HIV Disorders J Intensive Care Med, November 1, 2002; 17(6): 283 - 301. [Abstract] [PDF]
|
|
|
|
 |
|
 C. Alves, J.M. Nicolas, J.M. Miro, A. Torres, C. Agusti, J. Gonzalez, A. Rano, N. Benito, A. Moreno, F. Garcia, et al. Reappraisal of the aetiology and prognostic factors of severe acute respiratory failure in HIV patients Eur. Respir. J., January 1, 2001; 17(1): 87 - 93. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. G. Mansharamani, R. Garland, D. Delaney, and H. Koziel Management and Outcome Patterns for Adult Pneumocystis carinii Pneumonia, 1985 to 1995 : Comparison of HIV-Associated Cases to Other Immunocompromised States Chest, September 1, 2000; 118(3): 704 - 711. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Afessa and B. Green Clinical Course, Prognostic Factors, and Outcome Prediction for HIV Patients in the ICU : The PIP (Pulmonary Complications, ICU Support, and Prognostic Factors in Hospitalized Patients With HIV) Study Chest, July 1, 2000; 118(1): 138 - 145. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. AZOULAY, A. PARROT, A. FLAHAULT, D. CESARI, I. LECOMTE, P. ROUX, F. SAIDI, M. FARTOUKH, J.-F. BERNAUDIN, J. CADRANEL, et al. AIDS-related Pneumocystis carinii Pneumonia in the Era of Adjunctive Steroids . Implication of BAL Neutrophilia Am. J. Respir. Crit. Care Med., August 1, 1999; 160(2): 493 - 499. [Abstract] [Full Text]
|
|
|
|
 |
|
 J. S. Groeger, P. White Jr, D. M. Nierman, J. Glassman, W. Shi, D. Horak, and K. Price Outcome for Cancer Patients Requiring Mechanical Ventilation J. Clin. Oncol., March 1, 1999; 17(3): 991 - 991. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. D. Trachiotis, L. A. Vricella, D. Alyono, B. L. Aaron, and W. R. Hix Management of AIDS-Related Pneumothorax Ann. Thorac. Surg., December 1, 1996; 62(6): 1608 - 1613. [Abstract] [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
