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Outcome of mechanical ventilation in children with acquired immunodeficiency syndrome
J Marolda1, B Pace, R J Bonforte
1Jack and Lucy Clark Department of Pediatrics, Mount Sinai School of Medicine, New York, New York.
Insights
Mechanical ventilation for pediatric acquired immunodeficiency syndrome (AIDS) patients with respiratory failure shows limited long-term survival. While some children with AIDS can be weaned from ventilators, their prognosis remains poor.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Pulmonology
Background:
- Acquired immunodeficiency syndrome (AIDS) in children can lead to severe respiratory failure.
- Mechanical ventilation is a critical intervention for respiratory support in these patients.
Purpose of the Study:
- To evaluate the outcomes of pediatric patients with AIDS requiring mechanical ventilation.
- To identify factors associated with survival and mortality in this population.
Main Methods:
- Retrospective review of 18 pediatric patients with AIDS requiring mechanical ventilation.
- Analysis of common causes of respiratory failure, diagnostic yields of bronchial lavage, and survival rates.
- Comparison of clinical parameters between survivors and nonsurvivors.
Main Results:
- Pneumocystis carinii pneumonia (77%) and bacterial pneumonia (33%) were the most frequent causes of respiratory failure.
- Bronchial lavage demonstrated a high yield for P. carinii detection.
- 44% of patients were weaned from mechanical ventilation, but 50% of survivors died within 6 months.
Conclusions:
- Children with AIDS requiring mechanical ventilation can be weaned, indicating potential for short-term recovery.
- Despite successful weaning, the long-term prognosis for pediatric AIDS patients with respiratory failure remains unfavorable.
- Further research is needed to improve long-term outcomes for this vulnerable group.
Abstract:
We retrospectively reviewed the records of 18 children with acquired immunodeficiency syndrome (AIDS) who required mechanical ventilation for respiratory failure. These patients represented 35% of the patients seen with pulmonary disease and AIDS. The most common causes of respiratory failure were Pnuemocystis carinii pneumonia (77%) and bacterial pneumonia (33%). Bronchial lavage by fiberoptic bronchoscopy or endotracheal tube suctioning in mechanically ventilated children with AIDS had a high yield for P. carinii. Eight of 18 (44%) children survived the episode of respiratory failure and were weaned from the ventilator. However, four of eight survivors died within 6 months. Arterial oxygen tension on admission and maximum peak inspiratory pressure on the ventilator did not differ between survivors and nonsurvivors. We conclude that children with AIDS who are mechanically ventilated can be weaned from the respirator but that the subsequent course remains poor.