OUTCOME OF ICU TREATMENT IN INVASIVE ASPERGILLOSIS

Objective: To assess the outcome of intensive care treatment in invasi ve aspergillosis. Design: Retrospective study. Setting: University Hos pital, Medical Intensive Care Unit (ICU). Patients: Twenty-five patien ts with invasive aspergillosis who were admitted to the medical ICU in a 5 1/2 year period. Twenty-two had received high-dose chemotherapy f or (mainly hematologic) malignancies, one had been treated with cyclos porine and prednisolone for systemic lupus erythematosus, one with hig h-dose methylprednisolone for polyarteritis nodosa and one had an ARDS after near-drowning. Measurements and results: The medical records we re reviewed for patient and disease characteristics, outcome, reasons for admission to the ICU, supportive care and antifungal therapy as we ll as for the results of cultures and autopsy. Out of 25 patients, a d efinite ante mortem diagnosis could be established in seven. When auto psied patients were included, a total of 15 suffered from proven invas ive aspergillosis. Although standard antifungal treatment and maximal available supportive care were given, 23 of 25 patients (92%) died aft er a mean of 15 (1-51) days in the ICU. Both patients who recovered ha d received high-dose chemotherapy for hematologic malignancy and showe d bone marrow recovery and/or had a localized pulmonary infection. Con clusions: In patients with highly suspected or proven invasive aspergi llosis, admission to an ICU and mechanical ventilation should be consi dered in cases of localized infection and obvious signs of hematologic recovery, In most other circumstances ICU admission for mechanical ve ntilation does not seem to improve survival.