INTENSIVE-CARE OF PATIENTS WITH HIV-INFECTION - UTILIZATION, CRITICALILLNESSES, AND OUTCOMES

To examine intensive care unit (ICU) admission rates and diagnoses of patients with HIV infection, and to determine the outcomes of differen t critical illnesses, we analyzed data derived from the 63 patients wh o were admitted to an ICU from among the 1,130 adults with HIV infecti on who did not have AIDS at the time of enrollment in a multicenter pr ospective study. Patients were admitted and treated according to the j udgment of their physicians. During 4,298 patient-yea rs of follow-up for the entire cohort, there were 1,320 hospital admissions, of which 68 (5%) included admission to an ICU. Twenty-five (40%) of the patient s admitted to the ICU died during that admission. Twenty-four patients (38%) were admitted with a principal diagnosis of lung disease; 1 1 h ad Pneumocystis carinii pneumonia (PCP), one of whom was coinfected wi th Aspergillus fumigatus and Legionella pneumophilia, a nd six of them (55%) died. Four had bacterial pneumonia, two had pulmonary edema cau sed by renal failure, and one each had pulmonary tuberculosis, pulmona ry Kaposi's sarcoma, pneumothorax, adult respiratory distress syndrome , severe pulmonary fibrosis, cytomegalovirus pneumonitis, and metastat ic adenocarcinoma to the lungs. Eleven of these 14 patients (79%) died . Thirty-nine patients had 44 admissions for nonpulmonary diagnoses, i ncluding gastrointestinal disorders (14 admissions), cardiovascular di sorders (nine), sepsis syndrome (six), neurologic disorders (four), mo nitoring and ICU nursing care during or after a procedure (four), meta bolic disorders (three), trauma (two), drug overdose (one), and unknow n reasons (one). Nine (23%) of these patients died. Twenty-eight patie nts underwent mechanical ventilation, and 16 (57%) died. Seven (25%) h ad PCP (five died), seven had other primary pulmonary diseases (six di ed), and 14 were placed on mechanical ventilation for nonpulmonary dis orders (five died). Survival did not correlate with CD4 count determin ed within 6 mo of admission to the ICU. In conclusion, the range of in dications for critical care in patients with HIV infection is diverse. PCP accounted for only 16% of the ICU admissions, and mechanical vent ilation for PCP and other pulmonary disorders was associated with a hi gh mortality rate. In contrast, mechanical ventilation for nonpulmonar y disorders, and admission to the ICU for nonpulmonary diagnoses was a ssociated with a more favorable outcome.