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Outcome of tuberculous meningitis patients requiring mechanical ventilation
U K Misra1, J Kalita1, S Betai1
1Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Science, Raebareily Rd, Lucknow.
Purpose:
There is paucity of information about the outcome of tuberculous meningitis (TBM) patients on mechanical ventilation (MV). In this communication, we report the clinical characteristics, predictors of MV, and outcome of TBM patients requiring MV.
Method:
Thirty-eight (18%) of 205 patients with TBM requiring MV were included; and their demographic, clinical, cerebrospinal fluid, and magnetic resonance imaging finding at admission and follow-up were noted. The ventilator-related and systemic complications, hospital death, and 3-month functional outcome were noted. The predictors of need of MV were derived by multivariate regression analysis.
Results:
There were 38 MV and 36 non-MV TBM patients who were matched for age, sex, and stage of meningitis on admission. The requirement of MV was independently related to leukocytosis, seizure, and cerebrospinal fluid pleocytosis on admission. Patients on MV had higher frequency of septicemia (9 vs 2), bedsores (6 vs 0), and gastric hemorrhage (4 vs 0) compared with non-MV patients. Only 29% of MV patients survived and had poor outcome at 3 months; but in the non-MV group, all the patients survived, and only 11% had poor outcome.
Conclusion:
Mechanical ventilation was needed in 18% TBM patients because of TBM-related or systemic complications. Those requiring MV had high mortality and may be categorized separately.
Insights
Tuberculous meningitis (TBM) patients requiring mechanical ventilation (MV) had a high mortality rate and poor functional outcomes. These TBM patients often developed complications, unlike those not needing MV.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Tuberculous meningitis (TBM) is a severe infection with significant morbidity and mortality.
- Information on the outcomes of TBM patients requiring mechanical ventilation (MV) is limited.
Purpose of the Study:
- To report the clinical characteristics of TBM patients requiring MV.
- To identify predictors for MV requirement in TBM.
- To determine the outcomes of TBM patients on MV.
Main Methods:
- Retrospective analysis of 38 TBM patients requiring MV out of 205 total TBM patients.
- Data collected included demographics, clinical findings, cerebrospinal fluid analysis, and MRI findings.
- Ventilator-related complications, systemic complications, mortality, and 3-month functional outcomes were assessed.
Main Results:
- MV requirement was linked to leukocytosis, seizures, and cerebrospinal fluid pleocytosis.
- MV patients experienced higher rates of septicemia, bedsores, and gastric hemorrhage.
- Only 29% of MV patients survived with poor outcomes at 3 months, versus 100% survival in non-MV patients.
Conclusions:
- Mechanical ventilation was necessary for 18% of TBM patients due to disease or systemic complications.
- TBM patients requiring MV exhibit high mortality and may warrant separate classification.
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