IMPROVING LONG-TERM PROGNOSIS FOR SURVIVORS OF MECHANICAL VENTILATIONIN PATIENTS WITH AIDS WITH PCP AND ACUTE RESPIRATORY-FAILURE - 5-YEARFOLLOW-UP OF INTENSIVE-CARE-UNIT DISCHARGES

Background: Before 1987, the hospital survival of patients with acquir ed immunodeficiency syndrome, Pneumocystis carinii pneumonia, and acut e respiratory failure receiving mechanical ventilation was less than 1 5%. Hospital survival has improved since then, but concerns have been raised that the post-hospital discharge survival of these patients rem ains extremely poor. This study evaluated the long-term survival of pa tients discharged alive after an acute episode of acute respiratory fa ilure caused by P carinii pneumonia. Methods: A prospective cohort stu dy was conducted for the 5-year period from May 1987 through May 1992 in an urban teaching hospital. Forty-seven patients discharged from th e hospital after receiving mechanical ventilation and/or continuous po sitive airway pressure for acquired immunodeficiency syndrome, P carin ii pneumonia, and acute respiratory failure were followed up from thei r initial intensive care unit admission until death or termination of the study to measure the long-term survival and cumulative probability of survival of the study cohort. Actuarial life-table analysis was pe rformed, and long-term cumulative probability of survival was calculat ed on the basis of the life-table analysis. Median survival was estima ted by means of the product-limit method. Results: During the 5-year f ollow-up of the 47 subjects, 31 patients died, 12 were unavailable for followup, and four were still alive at the end of the cutoff. The cum ulative survival rate at 1 year was 80% (95% confidence interval, 92% to 68%); at 2 years, 49% (95%;, confidence interval, 65% to 34%); at 3 years, 18% (95% confidence interval, 32% to 4%); and at 4 years, 6% ( 95% confidence interval, 17%;, to 0%). Median survival time for all su bjects was 602 days (1.65 years), and the longest survival time for a single patient was 1774 days (4.86 years). Conclusions: Post-hospital discharge survival of patients with acquired immunodeficiency syndrome , P carinii pneumonia, and acute respiratory failure has improved dram atically in the past decade. Patients can undergo intubation and mecha nical ventilation with the hope of reasonable long-term survival.