The prognosis of respiratory failure in patients with tuberculous destroyed lung
Abstract:SETTING: The medical intensive care unit of a tertiary referral hospital.
OBJECTIVE: To determine the prognosis of patients whose lungs are damaged by previous and/or present tuberculosis infection and who have subsequently been presented with acute respiratory failure requiring mechanical ventilation.
DESIGN: A consecutive series of 38 patient cases with retrospective data analysis.
RESULTS: Pulmonary function test results for tests performed within the previous year were made available in 21 of the 38 cases (55%). These showed a mean (± SD) forced vital capacity (FVC) of 1.52 ± 0.46 L (41.0 ± 14.5% predicted), a forced expiratory volume/second (FEV1) of 0.77 ± 0.18 L (29.3 ± 13.6% predicted), and an FEV1/FVC ratio of 55.1 ± 16.2%. The acid-fast bacilli (AFB) positive group had a significantly higher mortality and more severe lung destruction when compared with the AFB-negative group. Patients with positive AFB were significantly more hypocapnic than those with negative AFB (6.4 ± 2.7 vs. 9.3 ± 3.9 kPa, P = 0.020). In multivariate analysis, the level of PaCO2 on admission was identified as the only significant prognostic index (OR 0.76, 95%CI 0.60–0.96).
CONCLUSION: Patients with positive AFB smears or cultures may have higher mortality rates than those with negative AFB in the tuberculosis destroyed lung patients with acute respiratory failure. A higher PaCO2 measurement could indicate a better survival rate in this group of patients.
Document Type: Regular Paper
Affiliations: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
Publication date: October 1, 2001
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