MANAGEMENT OF CHILDREN WITH TUBERCULOSIS ADMITTED TO A PEDIATRIC INTENSIVE-CARE UNIT

Objectives. To review the incidence, clinical features, ventilatory su pport and outcome of children with tuberculosis (TB) admitted to a Ped iatric Intensive Care Unit (PICU) in a region with an high incidence o f TB. Materials and methods. The study was performed in a PICU situate d in a province with a extremely high incidence of TB (>700 new cases/ 100 000/year), This is a retrospective descriptive study of TB admissi ons to the PICU in a 4-year period. Data regarding indications for adm ission, clinical picture, duration of ventilation, PICU and hospital s tay were collected from patient files. Outcome measures included morta lity and long term morbidity. Results. Of the 1862 children admitted t o the hospital for TB during the 4 years, 57 (3.1%) required PICU admi ssion (1 to 6% of annual admissions), Of these 57 children 41 (72%) we re admitted for respiratory failure, In 12 cases TB was the cause of t he respiratory failure, 17 cases suffered from other respiratory disea ses and in 12 cases the cause was nonrespiratory disease of which TB m eningitis (n = 8) was the most common. Mechanical ventilation was indi cated in 43 (75%) patients who were ventilated for 7.3 +/- 11.5 days, The duration of PICU admission was 10.2 +/- 2.4 days whereas the durat ion of hospitalization was 70.3 +/- 148.9 days. The PICU mortality was 23% with TB meningitis having the highest mortality of 75%. Conclusio ns. In a region with a high incidence of TB, tuberculous patients cons titute up to 6% of PICU admissions. A high degree of suspicion for the diagnosis is needed because in 30% of our cases the diagnosis was not initially considered.