Outcome of Intensive Care in Patients with the Acquired Immunodeficiency Syndrome

The prognosis of patients who become critically ill due to complications of the acquired immunodeficiency syndrome (AIDS) is generally believed to be poor, but no detailed studies have substantiated this impression. We performed a retrospective analysis of patients with AIDS admitted to the Medical Special Care Unit (MSCU) at Mount Sinai Medical Center in New York over a 42-month period. Of 910 patients admitted to the MSCU, 35 (4%) had AIDS. An additional patient admitted to the pediatric intensive care unit was included in the analysis. Respiratory failure occurred in 31 patients (86%) and was the most common problem necessitating admission. Twenty-five of these patients (69%) had Pneumocystis carinii pneumonia. All 31 patients with respiratory failure required endotracheal intubation and mechanical ventilation, and 27 (87%) died during the same hospitalization. Pneumothorax requiring tube thoracostomy occurred in 6 of 31 patients receiving mechanical ventilatory support. Among the 4 mechanically ventilated survivors, only 2 patients remain alive. Intensive care unit intervention in patients with AIDS and respiratory failure is associated with a poor outcome and probably does not alter the ultimate course in most cases.