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Improving long-term prognosis for survivors of mechanical ventilation in patients with AIDS with PCP and acute respiratory failure. Five-year follow-up of intensive care unit discharges.

BACKGROUND
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.