ETIOLOGY AND PROGNOSTIC FACTORS OF PATIENTS WITH AIDS PRESENTING LIFE-THREATENING ACUTE RESPIRATORY-FAILURE

Respiratory failure is a significant contributor to morbidity and mort ality in patients with the acquired immune deficiency syndrome (AIDS), We performed a study to investigate the aetiology, prognostic factors , and short- and long-term outcome of AIDS patients with life-threaten ing respiratory failure and pulmonary infiltrates, Forty-two AIDS pati ents (29 of whom required mechanical ventilation), admitted to a Respi ratory Intensive Care Unit (ICU) from 1985 to 1992 because of severe r espiratory failure (arterial oxygen tension/fractional inspiratory oxy gen (Pa,O-2/FI,O-2) ratio at hospital admission 19+/-14 kPa (mean+/-SD )) and diffuse pulmonary infiltrates, were studied for evaluation of t he aetiology and outcome, Necropsy studies were performed in 14 out of 23 (61%) patients who died, Pneumocystis carinii was the most common aetiology of pulmonary infiltrates (28 patients (67%)), Overall, 19 pa tients survived (45%) and 23 (55%) died, A multivariate analysis of pr ognostic factors influencing the outcome of the whole population showe d that the presence of P, carinii pneumonia and the requirement for me chanical ventilation (MV) were the major determinants of outcome for t his type of patient. The median survival time after ICU discharge for P, carinii pneumonia patients was lower (49 days) when compared to tha t of the remaining patients (154 days), Median survival time after ICU discharge for patients needing MV (112 days) did not differ from that observed in patients not requiring artificial ventilatory support (15 4 days), Although the ICU survival rate in this study was reasonable, 55% for the whole population, and 36% for P, carinii pneumonia patient s, the poor outcome after ICU discharge, in particular for P,carinii p neumonia patients, deserves the reassessment of ICU admission criteria for this type of AIDS population.