- © 2012 Marshfield Clinic
Comparing Outcomes of HIV versus Non-HIV Patients Requiring Mechanical Ventilation
- Vikas Pathak, MD*,†,1⇓,
- Iliana Samara Hurtado Rendon, MD*,
- Shebli Atrash, MD*,
- Vinay Prasad Rao Gagadam, MD*,
- Kaushik Bhunia, MD*,
- Syam Prasad Mallampalli, MD*,
- Vijay Vegesna, MD*,
- Mahesh Mani Dangal, MD* and
- Ronald L. Ciubotaru, MD‡
- *Department of Internal Medicine, St. Barnabas Hospital, Bronx, NY, USA
- †Department of Internal Medicine/Hospitalist, Marshfield Clinic, Marshfield, WI, USA
- ‡Department of Pulmonology/Intensive Care, St. Barnabas Hospital, Bronx, NY, USA
- Corresponding Author: Vikas Pathak, MD; Pulmonary Disease and Critical Care Medicine; University of North Carolina School of Medicine; 130 Mason Farm Rd; Chapel Hill, NC 27599 USA; Tel: (919) 966-2531; Fax: (919) 966-7013; E-mail: drvikaspathak{at}gmail.com
Abstract
Background Mechanical ventilation (MV) is a predictor of mortality in patients infected with human immunodeficiency virus (HIV) in the intensive care unit (ICU). Patients with HIV-infections are admitted to the ICU for a variety of reasons that frequently require intubation. While survival rates for HIV-infected patients continue to improve, ICU admission rates have remained consistent.
Methods To observe the consequences of MV in HIV-infected patients, we conducted a retrospective chart review on patients with HIV (n=55) vs. matched HIV-negative patients (n=55) who required MV over a one-year period and compared the groups for differences in outcome and complications.
Results The HIV group had twice the number of deaths (44% vs. 22%, all-cause mortality) (P=0.01). Among the HIV-positive group, 5 of 55 patients required tracheostomy and prolonged MV, compared to 15 of 55 in the control group (9% and 27%, respectively). Successful extubation was virtually identical (47% MV vs. 50% control). Ventilator-associated pneumonia (VAP) was significantly higher among HIV-positive cases (39 of 55 HIV vs. 14 of 55 non-HIV) (P=0.05). Regression analysis revealed that hypotension, hypoalbuminemia, and fever predicted a poorer outcome. Low CD4 cell counts were strongly associated with mortality.
Conclusion HIV-infected patients requiring MV have significantly higher mortality and VAP rates than HIV-negative patients. Since VAP is associated with a poor prognosis, discovering ways to prevent it in the HIV-infected patient may improve outcome.
