Pediatric Pulmonology 7:230-234 (1989) Outcome of Mechanical Ventilation in Children With Acq u i red I m m u nodef i ciency Syndrome Joanne Marolda, MD,' Bella Pace, MD,*Richard J. Bonforte, MD,~ Neal Kotin, MD,' and Meyer Kattan, MD, CM' zyxwv Summary. We retrospectively reviewed the records of 18 children with acquired immunodefi- ciency syndrome (AIDS) who required mechanical ventilation for respiratoly failure. These pa- tients represented 35% of the patients seen with pulmonary disease and AIDS. The most common causes of respiratoryfailure were zyxwvut fnuernocystis carinii pneumonia zyxw (77%) and bacterial pneumonia zyxwvutsrq (33%). Bronchial lavage by fiberoptic bronchoscopy or endotracheal tube suctioning in mechanically ventilated children with AIDS had a high yield for zyxwv f. carinii. Eight of 18 (44%) children survived the episode of respiratory failure and were weaned from the ventilator. How- ever, four of eight survivors died within 6 months. Arterial oxygen tension on admission and maximum peak inspiratory pressure on the ventilator did not differ between survivors and non- survivors. We conclude that children with AIDS who are mechanicallyventilated can be weaned from the respirator but that the subsequent course remains poor. Pediatr Pulmonol 1989; 7:230-234. Key words: Respiratory failure, etiology; BAL Pneumocystis carinii, LIP, bacterial viral pneumonias; survival rate, final outcome. INTRODUCTION zyxwvutsrq Pulmonary disease is a major cause of morbidity and mortality in children with acquired immune deficiency syndrome (AIDS). Defects in cell-mediated immunity predispose patients to develop opportunistic respiratory infections. zyxwvutsrq Pneumocystis zyxwvuts carinii pneumonia (PCP) is a frequently identified serious respiratory illness in children'7274 and has been diagnosed in 70% of the pe- diatric AIDS patients reported to the Centers for Disease Control (CDC).3 Life-threatening bacterial, fungal, and viral pneumonias have also been identified in children with AIDS. ,436-1 Pulmonary lymphoid hyperplasia (PLH) and lymphoid interstitial pneumonia (LIP) are fre- quently diagnosed in pediatric AIDS patients and con- tribute significantly to their morbidity and mortal- The dramatic rise in the number of children with AIDS and in the gravity of pulmonary complications has led to an increase in the number of children with respiratory failure. Acute respiratory failure in adult patients with AIDS has been associated with a mortality rate of 86- 100%. 14-18 Data on children with AIDS and respiratory failure are limited. A previous study of 3 1 children with respiratory failure and AIDS identified an 84% mortality rate. In an attempt to further delineate the spectrum of res- piratory failure as it pertains to children with AIDS, as well as the eventual outcome of its victims, the experi- ity. 235,123 13 ence of two pediatric intensive care units over a 6 year period was reviewed. MATERIALS AND METHODS Between January, 1982 and January, 1988,52 patients with the diagnosis of AIDS and pulmonary disease were admitted and treated at the Mount Sinai Hospital and Beth Israel Medical Center in New York City. The med- ical records of all children with AIDS and respiratory failure admitted to the intensive care units at these hos- pitals during this period were reviewed retrospectively. Acute respiratory failure was defined as the necessity for intubation and mechanical ventilation due to respira- tory distress. Patients requiring mechanical ventilation exhibited tachypnea, chest wall retractions, and nasal From the Jack and Lucy Clark Department of Pediatrics Mount Sinai School of Medicine,' and Department of Pediatrics, Beth Israel Med- ical Center,2 New York, New York. Received May 3, 1989; (revision) accepted for publication June 18, 1989. Supported in part by MCH Training Grant No. MCJ001069, U.S. Department of Health and Human Services. Address correspondence and reprint requests to Dr. Kattan, Mount Sinai Medical Center, Pediatric Pulmonary Division, Box 1202, One Gustave L. Levy Place, New York, NY 10029. 0 1989 Alan R. Liss, Inc.