Abstract
Extreme measures and vital resources are employed in trying to prevent children with acute lung injury secondary to Pneumocystis carinii pneumonia (PCP) from dying. However, the outcome of infants and children who present with PCP requiring intensive care management including mechanical ventilation is not clear from the literature. We reviewed the notes of all children admitted to our hospital who were HIV-positive and developed PCP between 1991 and 2000. We separated them into two groups on the basis of whether they were admitted to intensive care or were able to be managed on the general ward. Age at presentation of PCP, time from first AIDS presentation to first paediatric intensive care (PICU) admission, time spent on PICU, the number of re-admissions to PICU, method of PCP diagnosis, treatment received, and outcome were documented. Twenty-seven children were admitted to our institution. Nineteen (70%) required intensive care on at least one occasion, and three of these were still alive, 6 months following discharge from PICU and two are still alive at 30 months. Five children required at least two admissions. Seven (39%) died on intensive care, all aged less than 6 months. Of those who did not require PICU admission seven are still alive. Despite aggressive intensive care management, infants who are admitted to our PICU with respiratory failure from PCP and HIV infection at first AIDS presentation had an extremely poor prognosis.