Outcome of intensive care in patients with HIV infection.

OBJECTIVES: To examine ICU admission rates and diagnoses of patients with HIV infection and to determine the outcomes of different critical illnesses. DESIGN: Consecutive enrollment of patients admitted to the ICU with confirmed HIV infection or an AIDS-defining diagnosis. SETTING: Medical ICU of an urban teaching hospital. PATIENTS: 65 adult patients with documented HIV infection or AIDS-defining disorder. INTERVENTIONS: Standard care. RESULTS: In 1 year, there were 1,550 hospital admissions for patients with HIV infection, and 65 (4.2%) were admitted to the ICU. The mortality rate of patients admitted to the ICU was 51%; 35 (54%) were admitted with respiratory failure, 22 of whom had Pneumocystis carinii pneumonia (PCP). Sixteen patients with PCP required mechanical ventilation, and 13 (81%) died despite treatment with adjunctive corticosteroids. Other causes of respiratory failure included bacterial pneumonia, pulmonary tuberculosis, adult respiratory distress syndrome, and pulmonary Kaposi's sarcoma. Overall, 22 of 35 (63%) patients with respiratory failure died in the hospital. Thirty patients (46%) were admitted because of sepsis, neurologic disease, congestive heart failure, hypotension, or drug overdose. These patients had a mortality rate of 37%. Prior antiretroviral and anti-Pneumocystis prophylaxis did not influence outcome, but a body weight of 10% or more below ideal at the time of admission predicted poor survival. CONCLUSION: There is a diverse range of indications for critical care in patients with HIV infection. Although respiratory failure due to PCP was the most common reason for admission to the ICU, it accounted for only 34% of the cases. The prognosis of PCP in patients who require mechanical ventilation despite adjunctive corticosteroid treatment is poor.

Demographic influences on asthma hospital admission rates in New York City.

Surveillance reports describe an increase in asthma prevalence, and cite New York City as an area of excessive asthma mortality. To assess trends and the influence of geography, race, and ethnicity on hospital admission rates for asthma between 1989 and 1991, data of all admissions for asthma to New York City hospitals were reviewed. The average citywide annual hospital admission rate was 681 per 100,000 population, and the racial and ethnic distribution was 1,003 per 100,000 Hispanic patients, 810 per 100,000 for blacks, and 242 per 100,000 for whites (p < 0.0001). Bronx and Manhattan had the highest admissions rates, and contained a few zip codes with very high rates. In these zip codes, admission rates were consistently highest among Hispanics, followed by blacks and whites. New York City asthma admission rates increased 12.7 percent during the study. Very high admission rates among Hispanic patients and high rates in blacks, in specific geographic areas, are responsible for this trend. Targeted education and treatment programs could reduce hospital admissions and mortality in small geographic areas with high asthma morbidity.

Outcome of intensive care for patients with AIDS.

Data on the outcome of intensive care for patients with AIDS have been reported since 1984. Most published statistics focus on the outcome of respiratory failure due to Pneumocystis carinii pneumonia, the most frequent reason for admission to the ICU. Survival appears to be improving in recent years, partly due to the use of adjunctive corticosteroid therapy.