Long-term survival of patients with AIDS, Pneumocystis carinii pneumonia, and respiratory failure

Article Abstract:

During the first years of the acquired immunodeficiency syndrome (AIDS) epidemic, survival rates for those who suffered acute respiratory failure (ARF) as a complication were extremely low. Mortality for ARF caused by Pneumocystis carinii pneumonia (PCP) was over 85 percent. Because of the high mortality, there was controversy over whether to employ aggressive life-support measures, thereby using resources that might be put to better use for patients with a more optimistic prognosis. However, the long-term outlook for these patients has improved because of better therapies, especially zidovudine and the antibiotic prevention of PCP. Seventy-three patients were followed-up during the first year of a four-year study to determine how much survival had improved. The one-year survival rate was 37 percent for patients with AIDS, PCP and ARF, a much higher rate than found in previous studies. It is not entirely clear why these patients are surviving longer, but earlier diagnosis, the use of corticosteroids, treatment with zidovudine, and physicians' ''learning curve'' may play a role. In this study, only the use of corticosteroids was associated with longer survival. One third of all the patients survived at least one year, and 74 percent of patients who survived hospitalization were alive for one year or more. Respiratory failure from PCP no longer means that the patient is terminal, and such patients should not be excluded from aggressive care and treatment in the intensive care unit. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality

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Cost and outcome of intensive care for patients with AIDS, Pneumocystis carinii pneumonia, and severe respiratory failure

Article Abstract:

AIDS patients with Pneumocystis carinii pneumonia (PCP) and severe respiratory failure may not have been treated cost-effectively in intensive care units (ICUs) between 1989 and 1991. PCP is a common complication of AIDS that can lead to respiratory failure and death. Researchers evaluated the cost-effectiveness of treating 113 AIDS patients with PCP and severe respiratory failure in ICUs between 1981 and 1985, 1986 and 1988, and 1989 and 1991. Hospital billing records and patient outcome after ICU treatment were used as cost-effectiveness measures. Twenty-five percent of the patients were discharged from the hospital. Of these, 14% were treated between 1981 and 1985, 39% were treated between 1986 and 1988, and 24% were treated between 1989 and 1991. The average bill for ICU treatment, hospital care, and any future hospitalizations was $57,874. The cost of care per year of life saved was $305,795 between 1981 and 1985, $94,528 between 1986 and 1988, and $215,233 from 1989 to 1991.

Evaluation, Economic aspects, Medical care, Cost of, Health care costs, Intensive care units, Respiratory insufficiency

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Critical care of patients with AIDS

Article Abstract:

Several studies have found that two-thirds of AIDS patients in intensive care units (ICU) were admitted because of respiratory failure, most commonly due to Pneumocystis carinii pneumonia (PCP). While only zero to 14% of these patients survived to discharge between 1981 and 1985, 38% to 55% now survive. This is probably due to the use of corticosteroids in addition to pentamidine and trimethoprim/sulfamethoxazole to treat the patients' infection and respiratory failure. AIDS patients admitted to ICUs because of other opportunistic infections have an even better prognosis. Consequently, critical care for these patients should not be considered futile. All AIDS patients should be encouraged to have a living will in case they become unable to make decisions about critical care. Adoption of universal infection control procedures should protect health care workers caring for AIDS patients in the ICU.

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