Survival with Tuberculosis Pneumonia Necessitating Mechanical Ventilation

Respiratory failure requiring mechanical ventilation from tuberculosis is associated with mortality rates of up to 100%. Because the mortality rates were described before the development of advanced critical care technology and before the human immunodeficiency virus (HIV) infection, we evaluated the mortality rate of acute ventilator-dependent tuberculosis at our institution. Patients with the diagnosis of tuberculosis pneumonia were identified from chart review by sputum or biopsy confirmation and chest roentgenogram. Patients meeting these criteria who also required mechanical ventilation were selected for further study. Thirteen identified patients were treated at our inner city hospital from January 1, 1987, to August 31,1993. Outcome and the factors associated with survival and death were examined. Ages ranged from 29 to 75 years (mean, 44 years). Three patients survived (23% survival). Six of 10 deaths occurred in patients who had identifiable causes of immunosuppression, including steroid use and HIV infection. Two of the 3 survivors were white, and one had an identifiable cause of immunosuppression, diabetes. All patients were hypoalbuminemic on presentation to the hospital, with albumin levels ranging from 1.0 to 2.8 g/dL. No patient infected with HIV survived. The average time to intubation from admission to the hospital was 4 days for survivors and 1.3 days for nonsurvivors. There was no association between age, admission hemoglobin, temperature, white blood count, albumin, sodium, or monocyte count with survival. Although there is a high mortality rate in patients with active pulmonary tuberculosis requiring mechanical ventilation, it is not uniformly fatal. No patient with HIV infection survived in our study group.