Pneumocystis carinii pneumonia requiring intensive care management

Bédos, Jean‐Pierre; Dumoulin, Jean-Louis; Gachot, Bertrand; Veber, Benoît; Wolff, Michel; Régnier, B.; Chevret, Sylvie

doi:10.1097/00003246-199906000-00030

Cited by 57 publications

(11 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several prognostic markers of mortality for HIV-infected patients admitted to the ICU have earlier been identified in developed countries, which include Pneumocystis jirovecii pneumonia diagnosis, respiratory failure requiring mechanical ventilation, pneumothorax development, low serum albumin, and a high Acute Physiology and Chronic Health Evaluation (APACHE) II score (5, 8, 11, 19–21). However, the importance of these prognostic factors in developing countries has been poorly addressed.…”

mentioning

confidence: 99%

Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit

Croda

Neves

et al. 2009

Critical Care Medicine

102

View full text Add to dashboard Cite

Objective To evaluate the impact of antiretroviral therapy (ART) and the prognostic factors for in-intensive care unit (ICU) and 6-month mortality in human immunodeficiency virus (HIV)-infected patients. Design A retrospective cohort study was conducted in patients admitted to the ICU from 1996 through 2006. The follow-up period extended for 6 months after ICU admission. Setting The ICU of a tertiary-care teaching hospital at the Universidade de São Paulo, Brazil. Participants A total of 278 HIV-infected patients admitted to the ICU were selected. We excluded ICU readmissions (37), ICU admissions who stayed less than 24 hours (44), and patients with unavailable medical charts (36). Outcome Measure In-ICU and 6-month mortality. Main Results Multivariate logistic regression analysis and Cox proportional hazards models demonstrated that the variables associated with in-ICU and 6-month mortality were sepsis as the cause of admission (odds ratio [OR] = 3.16 [95% confidence interval [CI] 1.65– 6.06]); hazards ratio [HR] = 1.37 [95% CI 1.01–1.88]), an Acute Physiology and Chronic Health Evaluation II score > 19 [OR = 2.81 (95% CI 1.57–5.04); HR = 2.18 (95% CI 1.62–2.94)], mechanical ventilation during the first 24 hours [OR = 3.92 (95% CI 2.20–6.96); HR = 2.25 (95% CI 1.65–3.07)], and year of ICU admission [OR = 0.90 (95% CI 0.81– 0.99); HR = 0.92 [95% CI 0.87– 0.97)]. CD4 T-cell count <50 cells/mm3 was only associated with ICU mortality [OR = 2.10 (95% CI 1.17– 3.76)]. The use of ART in the ICU was negatively predictive of 6-month mortality in the Cox model [HR = 0.50 (95% CI 0.35– 0.71)], especially if this therapy was introduced during the first 4 days of admission to the ICU [HR = 0.58 (95% CI 0.41– 0.83)]. Regarding HIV-infected patients admitted to ICU without using ART, those who have started this treatment during ICU stay presented a better prognosis when time and potential confounding factors were adjusted for [HR 0.55 (95% CI 0.31– 0.98)]. Conclusions The ICU outcome of HIV-infected patients seems to be dependent not only on acute illness severity, but also on the administration of antiretroviral treatment. (Crit Care Med 2009; 37: 000–000)

show abstract

mentioning

confidence: 99%

Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit

Croda

Neves

et al. 2009

Critical Care Medicine

102

View full text Add to dashboard Cite

show abstract

“…For example, mortality rates were reported to be 76% in intubated patients and 91% in patients switched from NPPV to tracheal intubation [7]. Similarly, another study found that 3 of 4 intubated RA patients died, whereas all 12 patients without RA were intubated but survived after MV, and the mortality of RA patients was significantly low compared with non-RA patients [14].…”

Section: Discussionmentioning

confidence: 99%

“…First, the incidence of pneumothorax in previous reports ranged from 13 to 61% [6, 8, 10, 12, 15, 16]. The morality rate of mechanically ventilated PCP patients with pneumothorax ranged from 38 to 100% [4, 5, 8, 12], and development of pneumothorax appeared as one of the predictors for poor prognosis in PCP patients with [7] or without HIV [8]. In a previous study, NPPV avoided tracheal intubation in 67% of patients and decreased the incidence of pneumothorax from 37.5% to 8.3% [10].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, it is reported that 71% of NPPV failed in HIV-negative patients [12]. Delayed intubation could contribute to higher mortality [7]. Studies have shown that the mortality of intubated patients ranged from 59% to 91% [5–8, 10, 17, 18].…”

Section: Discussionmentioning

confidence: 99%

“…In HIV-negative patients, increased mortality rate was associated with positive end-expiratory pressure (PEEP) on the first three days of acute respiratory failure [6] and the development of pneumothorax during MV [7, 8]. MV was a risk factor for the poor prognosis of patients with severe PCP [1, 2, 5, 7–9], but whether or not MV is simply a marker of severity or itself is harmful in PCP patients is unclear. The finding, that noninvasive positive pressure ventilation (NPPV) decreased the incidence of pneumothorax [10, 11], indicates that invasive ventilation may be causing harm.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Risk Factors for the Mortality of Pneumocystis jirovecii Pneumonia in Non-HIV Patients Who Required Mechanical Ventilation: A Retrospective Case Series Study

Kotani

Katayama

Fukuda

et al. 2017

BioMed Research International

View full text Add to dashboard Cite

Background The risk factors for the mortality rate of Pneumocystis jirovecii pneumonia (PCP) who required mechanical ventilation (MV) remained unknown. Methods A retrospective chart review was performed of all PCP patients admitted to our intensive care unit and treated for acute hypoxemic respiratory failure to assess the risk factors for the high mortality. Results Twenty patients without human immunodeficiency virus infection required mechanical ventilation; 19 received noninvasive ventilation; and 11 were intubated. PEEP was incrementally increased and titrated to maintain FIO2 as low as possible. No mandatory ventilation was used. Sixteen patients (80%) survived. Pneumothorax developed in one patient with rheumatoid arthritis (RA). Median PEEP level in the first 5 days was 10.0 cmH2O and not associated with death. Multivariate analysis showed the association of incidence of interstitial lung disease and increase in serum KL-6 with 90-day mortality. Conclusions We found MV strategies to prevent pneumothorax including liberal use of noninvasive ventilation, and PEEP titration and disuse of mandatory ventilation may improve mortality in this setting. Underlying disease of interstitial lung disease was a risk factor and KL-6 may be a useful predictor associated with mortality in patients with RA. These findings will need to be validated in larger studies.

show abstract

Intensive Care Management in the Immunocompromised Patient with Pulmonary Infiltrates

Hilbert

Gruson

Vargas

2009

Pulmonary Infection in the Immunocompromised Patient

View full text Add to dashboard Cite

Pneumocystis carinii pneumonia requiring intensive care management

Abstract: Our data suggest that the most significant predictive factors of death were identifiable during the course of P. carinii pneumonia-related acute respiratory failure rather than at admission and can help in bedside decisions to withdraw intensive care support in such patients.

Cited by 57 publications

References 41 publications

Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit

Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit

Risk Factors for the Mortality of Pneumocystis jirovecii Pneumonia in Non-HIV Patients Who Required Mechanical Ventilation: A Retrospective Case Series Study

Intensive Care Management in the Immunocompromised Patient with Pulmonary Infiltrates

Contact Info

Product

Resources

About