Posted by James White
We found that HIV-related variables significantly influenced the in-hospital outcome and to a lesser extent, the in-ICU outcome. These variables were also closely associated with the long-term outcome. The number of previous opportunistic infections, as well as the stage and duration of AIDS, were significantly associated with the short- and long-term outcomes. The CD4 count is the prognostic marker most widely used in HIV-infected patients. However, as shown in Table 3 and Figure 2, differences in median and mean survival times across CD4+ lymphocyte count groups were modest. We believe that variations in CD4+ counts probably have little prognostic value in patients with CD4 counts <0.100X109/L. It has been reported that only logarithmic values are of interest in this population. HIV disease is a chronic disease that remains ultimately fatal, with a life expectancy that varies according to a number of clinical and laboratory marker 25,26 Clearly, the long-term outcome is closely dependent on this specific life expectancy. Bronchial Disease
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Posted by James White
Previously reported 1-year survival rates after ICU discharge of non-HIV-infected patients have varied widely in the few available studies, from about 30% in patients with severe sepsis and 49% in elderly subjects (with a mean survival time of 18 ±10 months) to <5% in patients who required cardiopulmonary resuscitation and in bone marrow transplant recipients. Our results in HIV-infected patients compare favorably with those previously reported for other high-risk patients or patients with ultimately fatal illnesses. Treatment of Bronchial Read the rest of this entry »
Posted by James White
Cumulative survival rates in the 281 patients who were discharged from the ICU were 51 ±38% at 6 months, 28±38% at 12 months, and 18±30% at 24 months. Table 3 shows long-term outcome univariate and multivariate analysis results, as well as crude mean and median survival times. Figure 1 shows survival curves according to the admission cause group and functional status, and Figure 2 shows survival curves according to HIV disease stage and CD4+ count. Bronchoscopy
Median and mean survival times were 429 days and 432±331 days in the PCP subgroup vs 311 days and 391 ±392 days in the other respiratory failure causes subgroup (p — 0.32). In the neurologic failure group, median and mean survival times were 75 days and 202 ±253 days in the toxoplasmic encephalitis subgroup, 34 days and 88 ±116 days in the intracerebral space-occupying lesion subgroup, and 188 days and 299 ±360 days in the meningitis subgroup; these differences were not statistically significant. Read the rest of this entry »
Posted by James White
Overall in-ICU and in-hospital mortality rates were 20.6% and 39.0%; other mortality rates were as follows: respiratory failure group, 16.7% and 33.9%; neurologic failure group, 23.2% and 41.1%; heart failure group, 25.0% and 68.8%; severe sepsis group, 38.9% and 58.3%; and miscellaneous admission causes group, 12.1% and 24.2%. Significant differences were found across admission groups for in-ICU (p=0.026) and in-hospital mortality rates (p=0.002). Mortality rates were lowest in the respiratory and miscellaneous groups, and highest in the neurologic, cardiac, and sepsis groups. Flexible Bronchoscopy
The mean time between ICU discharge and hospital discharge or death was 18.3±15.8 days (median, 20 days).
Results of the univariate and multivariate analysis for short-term outcomes in all 354 patients are presented in Table 2. Read the rest of this entry »
Posted by James White
The mean Glasgow coma scale score was 8.9±4 in the neurologic failure admission group. Toxoplasmic encephalitis contributed 62.1% of cases in this group (59 patients/95 patients) and 16.6% of all HIV-related admissions (59 patients/354 patients). A total of 21% of neurologic admissions (20 patients/95 patients) were for intracerebral lesions other than toxoplasmic encephalitis on cerebral imaging studies, including cerebral tuberculosis (5 patients), cryptococcosis (4 patients), nocardiosis (3 patients), cerebral lymphoma (5 patients), or other intracerebral space-occupying lesions such as progressive multifocal leukoencephalitis (3 patients). Patients with predominant clinical features of meningitis accounted for 16.8% (16 patients/95 patients) of neurologic admissions, with the diagnoses being nonopportunis-tic bacterial meningitis (4 patients), tuberculous meningitis (4 patients), nocardiosis (2 patients), and cryptococcal meningitis (6 patients). Causes of heart failure included acute or subacute tuberculous pericarditis (three patients), cryptococcal pericarditis (one patient), cardiac involvement in disseminated toxoplasmosis (one patient), cardiac lymphomas (one patient), beriberi (one patient), and HIV-related dilated cardiomyopathy (nine patients). Work of Breathing 1 Read the rest of this entry »
Posted by James White
Characteristics of the Population
Of the 1,258 admissions during the 3-year study period, 421 (33.5%) were HIV related. Only first ICU admissions were considered and the 67 admissions in patients who had already been admitted to the ICU were excluded from the analysis. The remaining 354 HIV-infected patients form the basis for this analysis. Among them, 280 (79%) had AIDS (according to CDC 1987 surveillance case definition). AIDS was diagnosed prior to the ICU admission in 149 patients, whereas the first AIDS-defining illness was the reason for ICU admission in the remaining 131 AIDS patients. Homosexuality or bisexuality was the most common risk factor (48.3%), followed by IV drug use (27.7%), blood transfusions (6.2%), African/Haitian origin (4.2%), and heterosexual transmission (2.2%). The mode of transmission was unknown in 11.4% of cases. Respiratory failure was the main cause of ICU admission (174 patients, 49.2%), followed by neurologic failure (95 patients, 26.8%), sepsis (36 patients, 10.2%), miscellaneous causes (33 patients, 9.3%), and heart failure (16 patients, 4.5%). Airway Obstruction diagnostic Read the rest of this entry »
Posted by James White
Study Population
The Clinique de Reanimation des Maladies Infectieuses is an 18-bed ICU located in the Hopital Bichat-Claude Bernard, a 1,300-bed university hospital in Paris, France. Data were recorded for all HIV-infected patients admitted to our ICU during the 3-year period from January 1, 1990, to December 31, 1992. We evaluated only the first ICU admission in each patient. Following admission, each patient was assigned by one of the staff physicians to one of the following five groups based on the cause of admission (the main organ failure requiring ICU admission was considered): respiratory failure, hypoxia requiring oxygen supplementation and/or mechanical ventilation related to a pulmonary disease; neurologic failure, altered consciousness and/or seizures not related to drug overdose or to metabolic disturbances; heart failure, refractory hypotension and/or evidence of hypoperfusion due to cardiac dysfunction as assessed based on an echocardiogram or right heart catheterization study (Swan-Ganz catheter); severe sepsis, as previously defined by Bone, ie, refractory hypotension and/or peripheral signs of hypoperfusion with microbiological evidence of infection; and miscellaneous, all other causes. Read the rest of this entry »