Risk Factors for Respiratory Failure Requiring Mechanical Ventilation in Patients With Pulmonary Tuberculosis

CHEST Journal ◽  
2012 ◽  
Vol 142 (4) ◽  
pp. 145A
Author(s):  
Tunn Ren Tay ◽  
Kim Huat Tee
2012 ◽  
Vol 23 (4) ◽  
pp. 173-178 ◽  
Author(s):  
Sandrine Valade ◽  
Laurent Raskine ◽  
Mounir Aout ◽  
Isabelle Malissin ◽  
Pierre Brun ◽  
...  

BACKGROUND: Despite effective treatments, tuberculosis-related mortality remains high among patients requiring admission to the intensive care unit (ICU).OBJECTIVE: To determine prognostic factors of death in tuberculosis patients admitted to the ICU, and to develop a simple predictive scoring system.METHODS: A 10-year, retrospective study of 53 patients admitted consecutively to the Hôpitaux de Paris, Hôpital Lariboisière (Paris, France) ICU with confirmed tuberculosis, was conducted. A multivariate analysis was performed to identify risk factors for death. A predictive fatality score was determined.RESULTS: Diagnoses included pulmonary tuberculosis (96%) and tuberculous encephalomeningitis (26%). Patients required mechanical ventilation (45%) and vasopressor infusion (28%) on admission. Twenty patients (38%) died, related to direct tuberculosis-induced organ failure (n=5), pulmonary bacterial coinfections (n=14) and pulmonary embolism (n=1). Using a multivariate analysis, three independent factors on ICU admission were predictive of fatality: miliary pulmonary tuberculosis (OR 9.04 [95% CI 1.25 to 65.30]), mechanical ventilation (OR 11.36 [95% CI 1.55 to 83.48]) and vasopressor requirement (OR 8.45 [95% CI 1.29 to 55.18]). A score generated by summing these three independent variables was effective at predicting fatality with an area under the ROC curve of 0.92 (95% CI 0.85 to 0.98).CONCLUSIONS: Fatalities remain high in patients admitted to the ICU with tuberculosis. Miliary pulmonary tuberculosis, mechanical ventilation and vasopressor requirement on admission were predictive of death.


2014 ◽  
Vol 62 (3) ◽  
pp. 177-182
Author(s):  
Aydın Çiledağ ◽  
Akın Kaya ◽  
Özlem Erçen Diken ◽  
Zeynep Pınar Önen ◽  
Elif Şen ◽  
...  

Respirology ◽  
2007 ◽  
Vol 12 (3) ◽  
pp. 406-411 ◽  
Author(s):  
Yon Ju RYU ◽  
Won-Jung KOH ◽  
Eun Hae KANG ◽  
Gee Young SUH ◽  
Man Pyo CHUNG ◽  
...  

Medicina ◽  
2010 ◽  
Vol 46 (7) ◽  
pp. 490 ◽  
Author(s):  
Astra Vitkauskienė ◽  
Erika Skrodenienė ◽  
Asta Dambrauskienė ◽  
Andrius Macas ◽  
Raimundas Sakalauskas

The aim of our study was to determine the prevalence of Pseudomonas aeruginosa bacteremia, risk factors, and outcome of patients treated at the Hospital of Kaunas University of Medicine. Material and methods. All hospitalized patients with blood culture positive for Pseudomonas aeruginosa during the 5-year period were included. A retrospective data analysis was performed to evaluate patients’ risk factors and mortality caused by P. aeruginosa bacteremia. Results. A total of 47 (58.8%) bacteremia episodes occurred in an intensive care unit (ICU). A primary source of bacteremia was identified in 50 (62.5%) episodes. Overall mortality rate was 58.8%. Univariate risk factors analysis showed the factors, which significantly increased the risk of death: mechanical ventilation (13.67 times, P<0.001), patient hospitalization in the ICU (8.51 times, P<0.001), acute respiratory failure (8.44 times, P<0.001), infection site in the respiratory tract (4.93 times, P=0.003), and central vein catheter (4.44 times, P=0.002). Timely and appropriate treatment and surgery were significant protective factors for 30-day mortality (11.1 and 5.26 times, respectively; P=0.001). Meropenem-resistant Pseudomonas aeruginosa strains caused bacteremia more frequently in patients older than 65 years than meropenem-sensitive strains (57.9%, n=11). All 19 patients with meropenem-resistant Pseudomonas aeruginosa bacteremia received inappropriate empirical antibiotic therapy. Conclusions. Treatment at the intensive care unit, mechanical ventilation, acute respiratory failure, source of infection in respiratory tract, and central vein catheter are the major risk factors associated with an increased mortality rate in patients with Pseudomonas aeruginosa bacteremia. The patients older than 65 years are at increased risk for bacteremia caused by carbapenemresistant Pseudomonas aeruginosa strains. Carbapenems are not antibiotics of the choice of treatment for Pseudomonas aeruginosa bacteremia at the Hospital of Kaunas University of Medicine.


Sign in / Sign up

Export Citation Format

Share Document