Rosen M J, Clayton K, Schneider R F, Fulkerson W, Rao A V, Stansell J, Kvale P A, Glassroth J, Reichman L B, Wallace J M, Hopewell P C
Department of Medicine, Beth Israel Medical Center, New York, New York 10003, USA.
Am J Respir Crit Care Med. 1997 Jan;155(1):67-71. doi: 10.1164/ajrccm.155.1.9001291.
To examine intensive care unit (ICU) admission rates and diagnoses of patients with HIV infection, and to determine the outcomes of different critical illnesses, we analyzed data derived from the 63 patients who were admitted to an ICU from among the 1,130 adults with HIV infection who did not have AIDS at the time of enrollment in a multicenter prospective study. Patients were admitted and treated according to the judgment of their physicians. During 4,298 patient-years 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 patients admitted to the ICU died during that admission. Twenty-four patients (38%) were admitted with a principal diagnosis of lung disease; 11 had Pneumocystis carinii pneumonia (PCP), one of whom was coinfected with Aspergillus fumigatus and Legionella pneumophilia, and six of them (55%) died. Four had bacterial pneumonia, two had pulmonary edema caused by renal failure, and one each had pulmonary tuberculosis, pulmonary Kaposi's sarcoma, pneumothorax, adult respiratory distress syndrome, severe pulmonary fibrosis, cytomegalovirus pneumonitis, and metastatic adenocarcinoma to the lungs. Eleven of these 14 patients (79%) died. Thirty-nine patients had 44 admissions for nonpulmonary diagnoses, including gastrointestinal disorders (14 admissions), cardiovascular disorders (nine), sepsis syndrome (six), neurologic disorders (four), monitoring and ICU nursing care during or after a procedure (four), metabolic disorders (three), trauma (two), drug overdose (one), and unknown reasons (one). Nine (23%) of these patients died. Twenty-eight patients underwent mechanical ventilation, and 16 (57%) died. Seven (25%) had PCP (five died), seven had other primary pulmonary diseases (six died), and 14 were placed on mechanical ventilation for nonpulmonary disorders (five died). Survival did not correlate with CD4 count determined within 6 mo of admission to the ICU. In conclusion, the range of indications for critical care in patients with HIV infection is diverse. PCP accounted for only 16% of the ICU admissions, and mechanical ventilation for PCP and other pulmonary disorders was associated with a high mortality rate. In contrast, mechanical ventilation for nonpulmonary disorders, and admission to the ICU for nonpulmonary diagnoses was associated with a more favorable outcome.
为了研究重症监护病房（ICU）收治HIV感染患者的比例及诊断情况，并确定不同危重病的治疗结果，我们分析了多中心前瞻性研究中1130例入组时未患艾滋病的成年HIV感染患者中63例入住ICU患者的数据。患者根据医生的判断入院并接受治疗。在对整个队列4298患者年的随访期间，共有1320次住院，其中68次（5%）包括入住ICU。入住ICU的患者中有25例（40%）在此次住院期间死亡。24例（38%）患者以肺部疾病为主诊断入院；11例患有卡氏肺孢子虫肺炎（PCP），其中1例合并烟曲霉和嗜肺军团菌感染，6例（55%）死亡。4例患有细菌性肺炎，2例因肾衰竭导致肺水肿，各有1例患有肺结核、肺卡波西肉瘤、气胸、成人呼吸窘迫综合征、严重肺纤维化、巨细胞病毒肺炎和肺转移性腺癌。这14例患者中有11例（79%）死亡。39例患者因非肺部诊断有44次入院，包括胃肠道疾病（14次入院）、心血管疾病（9次）、脓毒症综合征（6次）、神经系统疾病（4次）、手术期间或术后的监测及ICU护理（4次）、代谢紊乱（3次）、创伤（2次）、药物过量（1次）及不明原因（1次）。这些患者中有9例（23%）死亡。28例患者接受了机械通气，16例（57%）死亡。7例（25%）患有PCP（5例死亡），7例患有其他原发性肺部疾病（6例死亡），14例因非肺部疾病接受机械通气（5例死亡）。生存率与入住ICU后6个月内测定的CD4细胞计数无关。总之，HIV感染患者重症监护的适应证范围广泛。PCP仅占ICU入院病例的16%，因PCP和其他肺部疾病进行机械通气的死亡率很高。相比之下，因非肺部疾病进行机械通气以及因非肺部诊断入住ICU的预后较好。
