Mechanical Ventilation for Pneumocystis сarinii Pneumonia in Patients With the Acquired Immunodeficiency Syndrome: Treatment
Fourteen patients were initially hospitalized in ICUs (3 survivors and 11 nonsurvivors). The 19 others (3 survivors and 16 nonsurvivors) were hospitalized for 6.9 ±6.3 days (range, 1 to 22 days) before they were transferred to ICUs. The antiparasitic treatment had been started in 14 patients 7 ±5.6 days before their transfer (range, 3 to 22 days) and in almost all of them, the steroids were associated to cotrimoxazole four times.
Three patient groups were defined according to the period during which TMP-SMZ and steroids were given before the beginning of MV, as follows: group 1 (n = 10) less than 5 days of TMP-SMZ with (n = 9) or without (n = 1) steroids; group 2 (n = 4) 5 days or more of TMP-SMZ and less than 5 days of steroids; group 3 (n = 19) 5 days or more of TMP-SMZ and steroids. This latter group represented the treatment failures (Table 2). canadianneighborpharmacy.com
The overall mortality rate was 81.8 percent (27/33 patients). Death associated with ARF occurred 20 ±9.8 days after the beginning of treatment (range, 6 to 54 days) and after 11.4 ±9.9 days of MV (range, 1 to 46 days). The mortality rate among patients placed on a regimen of M V after failure of medical treatment (group 3) was 94.7 percent, compared with 50 percent in group 1 (p = 0.02).
Among the survivors (Table 3), five were in group 1 and one was in group 3. There was no significant difference between the survivors and nonsurvivors in terms of duration of symptoms before admission, age, simplified acute physiology score, P&02, lactate dehydrogenase activity or the CD4 lymphocyte count at admission (Table 4).