Improving Long-term Prognosis for Survivors of Mechanical Ventilation in Patients With AIDS With PCP and Acute Respiratory Failure

Abstract

Before 1987, the hospital survival of patients with acquired immunodeficiency syndrome, Pneumocystis carinii pneumonia, and acute respiratory failure receiving mechanical ventilation was less than 15%. Hospital survival has improved since then, but concerns have been raised that the post-hospital discharge survival of these patients remains extremely poor. This study evaluated the long-term survival of patients discharged alive after an acute episode of acute respiratory failure caused by P carinii pneumonia. A prospective cohort study was conducted for the 5-year period from May 1987 through May 1992 in an urban teaching hospital. Forty-seven patients discharged from the hospital after receiving mechanical ventilation and/or continuous positive airway pressure for acquired immunodeficiency syndrome, P carinii pneumonia, and acute respiratory failure were followed up from their initial intensive care unit admission until death or termination of the study to measure the long-term survival and cumulative probability of survival of the study cohort. Actuarial life-table analysis was performed, and long-term cumulative probability of survival was calculated on the basis of the life-table analysis. Median survival was estimated by means of the product-limit method. During the 5-year follow-up of the 47 subjects, 31 patients died, 12 were unavailable for follow-up, and four were still alive at the end of the cutoff. The cumulative survival rate at 1 year was 80% (95% confidence interval, 92% to 68%); at 2 years, 49% (95% confidence interval, 65% to 34%); at 3 years, 18% (95% confidence interval, 32% to 4%); and at 4 years, 6% (95% confidence interval, 17% to 0%). Median survival time for all subjects was 602 days (1.65 years), and the longest survival time for a single patient was 1774 days (4.86 years). Post-hospital discharge survival of patients with acquired immunodeficiency syndrome, P carinii pneumonia, and acute respiratory failure has improved dramatically in the past decade. Patients can undergo intubation and mechanical ventilation with the hope of reasonable long-term survival.