Long-term Survival of Patients With AIDS, Pneumocystis carinii Pneumonia, and Respiratory Failure

Objective. —To evaluate the long-term survival of patients admitted to the medical intensive care unit, Cook County Hospital, Chicago, Ill, with Pneumocystis carinii pneumonia and acute respiratory failure.

Design. —Cohort study over a 4-year period.

Setting. —Municipal teaching hospital.

Patients. —Seventy-three consecutive patients who had 75 episodes of P carinii pneumonia and acute respiratory failure were followed up from the time of hospital admission until their deaths or the termination of the study.

Outcome Measures. —Duration of survival from the time of initial hospital admission with diagnoses of P carinii pneumonia and acute respiratory failure.

Results. —Consistent with recent reports of improved short-term outcome, the immediate hospital survival was 47% (35/75). The 1-year survival was 37% (95% confidence interval, 26% to 49%). Two patients have survived for 40 months. Almost three quarters of the patients who survived hospitalization lived for at least 1 year.

Conclusions. —The long-term prognosis for patients with the acquired immunodeficiency syndrome, P carinii pneumonia, and acute respiratory failure is now substantially better than anticipated. Respiratory failure due to P carinii pneumonia does not necessarily signify the terminal phase of human immunodeficiency virus infection. Accordingly, patients with the acquired immunodeficiency syndrome, P carinii pneumonia, and acute respiratory failure can be appropriate candidates for life support in medical intensive care units.

(JAMA. 1991;266:89-92)