Improved outcome for young children with AIDS, Pneumocystis carinii pneumonia, and acute respiratory failure.

OBJECTIVE

To describe the clinical course of children with acquired immunodeficiency syndrome, requiring mechanical ventilation secondary to Pneumocystis carinii pneumonia, with respect to intensive care unit outcome, long-term survival after intensive care unit discharge, and possible predictors of outcome.

DESIGN

Retrospective case series.

SETTING

Multidisciplinary, tertiary, pediatric intensive care unit.

PATIENTS

Thirteen consecutive patients accounting for 15 admissions to the intensive care unit, from September 1986 through December 1991, with the diagnoses of acquired immunodeficiency syndrome, P. carinii pneumonia, and acute respiratory failure requiring mechanical ventilation.

RESULTS

All patients were less than 2 years of age and acquired human immunodeficiency virus infection perinatally. Survival after 15 admissions to the intensive care unit was 60%. Mean (+/- SD) and median long-term survival for the nine intensive care unit survivors was 30 +/- 12.9 months and 27 months, respectively. Maximum oxygenation index and minimum partial pressure of arterial oxygen to fraction of inspired oxygen ratio were significantly different between survivors and nonsurvivors.

CONCLUSIONS

Young children with acquired immunodeficiency syndrome who develop acute respiratory failure secondary to P. carinii pneumonia and who require mechanical ventilation may have a better acute outcome and long-term survival than previously reported.