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September 1992, Vol 146, No. 9 >
Article | September 1992

The Role of Assisted Ventilation in Survival After Respiratory Failure in Children With AIDS FREE

Douglas L. Abadco, MD; Madu Rao, MD; Richard E. Kravath, MD; Phillip Steiner, MD
[+] Author Affiliations

Accepted for publication December 16, 1991.

Presented in part at the Eastern Society for Pediatric Research, New York, NY, October 20, 1990.

Reprint requests to Department of Pediatrics, Box 49, SUNY Health Science Center at Brooklyn, 450 Clarkson Ave, Brooklyn, NY 11203 (Dr Abadco).


Am J Dis Child. 1992;146(9):1052-1055. doi:10.1001/archpedi.1992.02160210054020.
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• Objectives.  —To determine the role of assisted ventilation in children with the acquired immunodeficiency syndrome and acute respiratory failure, and to identify any measurement or variable that predicted survival.

Design.  —Retrospective study.

Setting.  —Kings County (New York) Hospital Center, a tertiary-level inner-city municipal hospital.

Participants.  —Twenty-three children with acquired immunodeficiency syndrome who were endotracheally intubated and mechanically ventilated because of acute respiratory failure.

Measurements/Main Results.  —There were 24 episodes of acute respiratory failure, as one patient survived a first episode and died during the second episode 2 years later. We failed to identify any measurement or variable that predicted survival. During 12 episodes (50%), the patients survived and were weaned from the ventilator.

Conclusions.  —Our findings indicate that a decision to avoid intubation and assisted ventilation in a child with acquired immunodeficiency syndrome and acute respiratory failure should not be made based merely on the presumption of a lethal outcome.(AJDC. 1992;146:1052-1055)

REFERENCES

1 +
Wilkinson JD, Greenwald BM.  The acquired immunodeficiency syndrome: impact on the pediatric intensive care unit . Crit Care Clin . 1988;;4: 831-844.
2 +
Rubinstein A, Morecki R, Goldman H.  Pulmonary disease in infants and children: pulmonary effects of AIDS . Clin Chest Med . 1988;;9:507-517.
3 +
Rubinstein A, Morecki R, Siverman B, et al.  Pulmonary disease in children with acquired immunodeficiency syndrome and AIDS-related complex . J Pediatr . 1986;;108:498-503.
4 +
Rogers MF.  AIDS in children: a review of the clinical, epidemiologic and public health aspects . Pediatr Infect Dis . 1985;;4:230-236.
5 +
Scott GB, Buck BE, Leterman JG, Bloom FL, Parks WP.  Acquired immunodeficiency syndrome in infants . N Engl J Med . 1984;;310:76-81.
6 +
Scott G, Hutto C, Makuch R, et al.  Survival in children with perinatally acquired human immunodeficiency virus type 1 infection . N Engl J Med . 1989;;321:1791-1796.
7 +
Novello AC, Wise PH, Willoughby A, Pizzo P.  Final report of the United States Department of Health and Human Services Secretary's Work Group on pediatric human immunodeficiency virus infection and disease: content and implications . Pediatrics . 1989;;84:547-555.
8 +
Murray JF, Felton CP, Garay SM, et al.  Pulmonary complications of the acquired immunodeficiency syndrome: report of a National Heart, Lung and Blood Institute workshop . N Engl J Med . 1984;;310:1682-1688.
9 +
Wachter RM, Luce JM, Turner J, Volberding P, Hopewell PC.  Intensive care of patients with the acquired immunodeficiency syndrome: outcome and changing patterns of utilization . Am Rev Respir Dis . 1986;;134:891-896.
10 +
Stover DE, White DA, Romano PA, Gellene RA, Robeson WA.  Spectrum of pulmonary diseases associated with the acquired immunodeficiency syndrome . Am J Med . 1985;;78:429-437.
11 +
Schein RMH, Fischl MA, Pitchenik AE, Sprung CL.  ICU survival of patients with the acquired immunodeficiency syndrome . Crit Care Med . 1986;; 1412:1026-1027.
12 +
Rosen MJ, Cucco RA, Teirstein AS.  Outcome of intensive care in patients with the acquired immunodeficiency syndrome . J Intensive Care Med . 1986;;1:55-60.
13 +
Deam R, Kimberly APS, Anderson M, Soni N.  AIDS in ICUs: outcome . Anesthesia . 1988;;43:150-151.
14 +
Vernon DD, Holzman BH, Lewis P, Scott GB, Birriel JA, Scott MB.  Respiratory failure in children with acquired immunodeficiency syndrome and acquired immunodeficiency syndrome-related complex . Pediatrics . 1988;;82:223-228.
15 +
Marolda J, Pace B, Bonforte RJ, Kotin N, Kattan M.  Outcome of mechanical ventilation in children with acquired immunodeficiency syndrome . Pediatr Pulmonol . 1989;;7:230-234.
16 +
Notterman DA, Greenwald BM, Di Maio-Hunter A, Wilkinson JD, Krasinski K, Borkowsky W.  Outcome after assisted ventilation in children with acquired immunodeficiency syndrome . Crit Care Med . 1990;;18:18-20.
17 +
Centers for Disease Control.  Classification system for human immunodeficiency virus (HIV) infection in children under 13 years of age . MMWR Morb Mortal Wkly Rep . 1987;;36:225-230.
18 +
Amaro-Galvez R, Rao M, Abadco D, Kravath RE, Steiner P.  Nonbronchoscopic bronchoalveolar lavage in ventilated children with acquired immunodeficiency syndrome: a simple and effective diagnostic method for Pneumocystis carinii infection . Pediatr Infect Dis J . 1991;;10:473-475.
19 +
El-Sadr W, Simberkoff MS.  Survival and prognostic factors in severe Pneumocystis carinii pneumonia requiring mechanical ventilation . Am Rev Respir Dis . 1988;;137:1264-1267.
20 +
Efferen LS, Nadarajah D, Palat DS.  Survival following mechanical ventilation for Pneumocystis cariniipneumonia in patients with the acquired immunodeficiency syndrome: a different perspective . Am J Med . 1989;;87: 401-404.
21 +
Luce JM, Wachter RM, Hopewell PC.  Intensive care of patients with the acquired immunodeficiency syndrome: time for a reassessment? Am Rev Respir Dis . 1988;;137:1261-1263.
22 +
Weiland JE, Davis WB, Holter JF, et al.  Lung neutrophils in the adult respiratory distress syndrome: clinical and pathophysiologic significance . Am Rev Respir Dis . 1986;;133:218-225.
23 +
Smith RL, El-Sadr WM, Lewis ML.  Correlation of bronchoalveolar lavage cell populations with clinical severity of Pneumocystis carinii pneumonia . Chest . 1988;;92:60-64.
24 +
Mason GR, Hashimoto CH, Dickman PS, Foutty LF, Cobb CJ.  Prognostic implications of bronchoalveolar lavage neutrophilia in patients with Pneumocystis carinii pneumonia and AIDS . Am Rev Respir Dis . 1989;; 139:1336-1342.
25 +
Rinaldo JE, Borovetz H.  Deterioration of oxygenation and abnormal lung microvascular permeability during resolution of leukopenia in patients with diffuse lung injury . Am Rev Respir Dis . 1985;;131:579-583.

Figures

Tables

Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Wilkinson JD, Greenwald BM.  The acquired immunodeficiency syndrome: impact on the pediatric intensive care unit . Crit Care Clin . 1988;;4: 831-844.
2 +
Rubinstein A, Morecki R, Goldman H.  Pulmonary disease in infants and children: pulmonary effects of AIDS . Clin Chest Med . 1988;;9:507-517.
3 +
Rubinstein A, Morecki R, Siverman B, et al.  Pulmonary disease in children with acquired immunodeficiency syndrome and AIDS-related complex . J Pediatr . 1986;;108:498-503.
4 +
Rogers MF.  AIDS in children: a review of the clinical, epidemiologic and public health aspects . Pediatr Infect Dis . 1985;;4:230-236.
5 +
Scott GB, Buck BE, Leterman JG, Bloom FL, Parks WP.  Acquired immunodeficiency syndrome in infants . N Engl J Med . 1984;;310:76-81.
6 +
Scott G, Hutto C, Makuch R, et al.  Survival in children with perinatally acquired human immunodeficiency virus type 1 infection . N Engl J Med . 1989;;321:1791-1796.
7 +
Novello AC, Wise PH, Willoughby A, Pizzo P.  Final report of the United States Department of Health and Human Services Secretary's Work Group on pediatric human immunodeficiency virus infection and disease: content and implications . Pediatrics . 1989;;84:547-555.
8 +
Murray JF, Felton CP, Garay SM, et al.  Pulmonary complications of the acquired immunodeficiency syndrome: report of a National Heart, Lung and Blood Institute workshop . N Engl J Med . 1984;;310:1682-1688.
9 +
Wachter RM, Luce JM, Turner J, Volberding P, Hopewell PC.  Intensive care of patients with the acquired immunodeficiency syndrome: outcome and changing patterns of utilization . Am Rev Respir Dis . 1986;;134:891-896.
10 +
Stover DE, White DA, Romano PA, Gellene RA, Robeson WA.  Spectrum of pulmonary diseases associated with the acquired immunodeficiency syndrome . Am J Med . 1985;;78:429-437.
11 +
Schein RMH, Fischl MA, Pitchenik AE, Sprung CL.  ICU survival of patients with the acquired immunodeficiency syndrome . Crit Care Med . 1986;; 1412:1026-1027.
12 +
Rosen MJ, Cucco RA, Teirstein AS.  Outcome of intensive care in patients with the acquired immunodeficiency syndrome . J Intensive Care Med . 1986;;1:55-60.
13 +
Deam R, Kimberly APS, Anderson M, Soni N.  AIDS in ICUs: outcome . Anesthesia . 1988;;43:150-151.
14 +
Vernon DD, Holzman BH, Lewis P, Scott GB, Birriel JA, Scott MB.  Respiratory failure in children with acquired immunodeficiency syndrome and acquired immunodeficiency syndrome-related complex . Pediatrics . 1988;;82:223-228.
15 +
Marolda J, Pace B, Bonforte RJ, Kotin N, Kattan M.  Outcome of mechanical ventilation in children with acquired immunodeficiency syndrome . Pediatr Pulmonol . 1989;;7:230-234.
16 +
Notterman DA, Greenwald BM, Di Maio-Hunter A, Wilkinson JD, Krasinski K, Borkowsky W.  Outcome after assisted ventilation in children with acquired immunodeficiency syndrome . Crit Care Med . 1990;;18:18-20.
17 +
Centers for Disease Control.  Classification system for human immunodeficiency virus (HIV) infection in children under 13 years of age . MMWR Morb Mortal Wkly Rep . 1987;;36:225-230.
18 +
Amaro-Galvez R, Rao M, Abadco D, Kravath RE, Steiner P.  Nonbronchoscopic bronchoalveolar lavage in ventilated children with acquired immunodeficiency syndrome: a simple and effective diagnostic method for Pneumocystis carinii infection . Pediatr Infect Dis J . 1991;;10:473-475.
19 +
El-Sadr W, Simberkoff MS.  Survival and prognostic factors in severe Pneumocystis carinii pneumonia requiring mechanical ventilation . Am Rev Respir Dis . 1988;;137:1264-1267.
20 +
Efferen LS, Nadarajah D, Palat DS.  Survival following mechanical ventilation for Pneumocystis cariniipneumonia in patients with the acquired immunodeficiency syndrome: a different perspective . Am J Med . 1989;;87: 401-404.
21 +
Luce JM, Wachter RM, Hopewell PC.  Intensive care of patients with the acquired immunodeficiency syndrome: time for a reassessment? Am Rev Respir Dis . 1988;;137:1261-1263.
22 +
Weiland JE, Davis WB, Holter JF, et al.  Lung neutrophils in the adult respiratory distress syndrome: clinical and pathophysiologic significance . Am Rev Respir Dis . 1986;;133:218-225.
23 +
Smith RL, El-Sadr WM, Lewis ML.  Correlation of bronchoalveolar lavage cell populations with clinical severity of Pneumocystis carinii pneumonia . Chest . 1988;;92:60-64.
24 +
Mason GR, Hashimoto CH, Dickman PS, Foutty LF, Cobb CJ.  Prognostic implications of bronchoalveolar lavage neutrophilia in patients with Pneumocystis carinii pneumonia and AIDS . Am Rev Respir Dis . 1989;; 139:1336-1342.
25 +
Rinaldo JE, Borovetz H.  Deterioration of oxygenation and abnormal lung microvascular permeability during resolution of leukopenia in patients with diffuse lung injury . Am Rev Respir Dis . 1985;;131:579-583.

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