A comparison of seriously ill patients with or without AIDS requiring prolonged mechanical ventilation

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• 作者：J. Dermot Frengley ; MB ; ChB ; MSc ; FRCP^a ; ^b ; ^{dermot.frengley@nychhc.org} ; Giorgio R. Sansone ; PhD^b ; Kiranjit Uppal ; MPH^b ; John J. Vecchione ; MD^b ; Robert J. Kaner ; MD^c ; ^d
• 关键词：AIDS ; Prolonged mechanical ventilation ; Weaning outcomes ; Discharge disposition ; Survival
• 刊名：Journal of Critical Care
• 出版年：2012
• 出版时间：December, 2012
• 年：2012
• 卷：27
• 期：6
• 页码：594-601
• 全文大小：337 K

文摘

Purpose

The aim of this study was to compare differences in underlying diagnoses, weaning outcomes, discharge disposition, and survival in prolonged mechanical ventilator (PMV)-dependent patients with and without AIDS.

Methods

Ninety consecutive AIDS patients requiring PMV were retrospectively matched with 90 clinically similar non-AIDS patients to form matched cohorts to determine differences in their outcomes.

Results

AIDS patients had more acute diagnoses requiring PMV, whereas non-AIDS patients had more chronic diagnoses (P < .001). Weaning outcomes were alike with 31 (35 % ) AIDS and 37 (41 % ) non-AIDS patients successfully weaned. More AIDS patients went home, and fewer, to nursing facilities (P = .04). In each cohort, successfully weaned patients had significantly longer survival than their unweaned counterparts (all P < .001). Successful weaning reduced the risk of death in AIDS and non-AIDS patients (hazard ratios, 0.29 and 0.20; 95 % confidence intervals, 0.17-0.50 and 0.11-0.36, respectively; all P < .001).

Conclusions

AIDS had little effect on weaning success or survival. Successful weaning increased survival regardless of a diagnosis of AIDS. The AIDS patients had more home discharges and fewer to nursing facilities, which likely resulted from the AIDS patients having more acute illnesses leading to PMV than the non-AIDS patients.