Outcome of mechanical ventilation in children infected with the human immunodeficiency virus

Objective. To evaluate and compare the outcome of HIV-positive (HIV+) and n egative (HIV-) paediatric patients presenting with severe community-acquire d pneumonia and requiring mechanical ventilation for respiratory failure. Design. Prospective descriptive analysis. Setting, Multidisciplinary intensive care unit (ICU) in a tertiary care uni versity-based referral hospital, staffed by paediatric intensivists and ana esthetists. Patients. All 110 paediatric patients admitted to the ICU with severe commu nity-acquired pneumonia requiring mechanical ventilation during the 2 years 1992 through 1993. No patient had any defined clinical manifestations of a cquired immunodeficiency syndrome on admission to the ICU. Methods. HIV Infective status was determined by p24 antigen detection. Age, nutritional status, predicted mortality, ventilatory requirements, oxygena tion indices, other organ dysfunction and mortality were compared between t he 17 HIV+ and 93 HIV- patients. Results. The patient groups did not differ significantly with regard to age pr nutritional status. The ventilatory requirement measurements, positive end-expiratory pressure time product,fraction of inspired oxygen (FiO(2)) t ime product, and measurements of oxygenation were significantly worse in; H IV+ patients. HIV+ patients had a mean predicted mortality of 40.1% compare d with 22.2% in HIV- patients on admission. Mortality was close to predicte d in the HIV- group at 31% (29/93),while in the HIV+ patients mortality at 88% (15/17) was significantly worse than predicted. All deaths in the HIVgroup were due to severe respiratory failure.