Clinical impact of pneumothorax in patients with Pneumocystis jirovecii pneumonia and respiratory failure in an HIV-negative cohort

BMC Pulmonary Medicine

Song Yee Kim¹  Ah Young Leem¹  Su Hwan Lee¹  Young Sam Kim¹  Moo Suk Park¹  Kyungsoo Chung¹  Ji Ye Jung¹  Sang Hoon Lee¹  Seung Hyun Yong¹  Young Ae Kang¹  Eun Young Kim¹  Min Chul Kim²  Sung Ryeol Kim²  Se Hyun Kwak²  Eun Hye Lee²  Ji Soo Choi²  Chang Hwan Seol²  Byung Hoon Park² 

[1] Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea;Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea;

关键词: Pneumonia;    Pneumocystis;    Respiratory insufficiency;    Pneumothorax;    Prognosis;    Risk factors;   

DOI  :  10.1186/s12890-021-01812-z

来源: Springer

【 摘 要 】

BackgroundPneumocystis jirovecii pneumonia (PCP) with acute respiratory failure can result in development of pneumothorax during treatment. This study aimed to identify the incidence and related factors of pneumothorax in patients with PCP and acute respiratory failure and to analyze their prognosis.MethodsWe retrospectively reviewed the occurrence of pneumothorax, including clinical characteristics and results of other examinations, in 119 non-human immunodeficiency virus patients with PCP and respiratory failure requiring mechanical ventilator treatment in a medical intensive care unit (ICU) at a tertiary-care center between July 2016 and April 2019.ResultsDuring follow up duration, twenty-two patients (18.5%) developed pneumothorax during ventilator treatment, with 45 (37.8%) eventually requiring a tracheostomy due to weaning failure. Cytomegalovirus co-infection (odds ratio 13.9; p = 0.013) was related with occurrence of pneumothorax in multivariate analysis. And development of pneumothorax was not associated with need for tracheostomy and mortality. Furthermore, analysis of survivor after 28 days in ICU, patients without pneumothorax were significantly more successful in weaning from mechanical ventilator than the patients with pneumothorax (44% vs. 13.3%, p = 0.037). PCP patients without pneumothorax showed successful home discharges compared to those who without pneumothorax (p = 0.010).ConclusionsThe development of pneumothorax increased in PCP patient with cytomegalovirus co-infection, pneumothorax might have difficulty in and prolonged weaning from mechanical ventilators, which clinicians should be aware of when planning treatment for such patients.

【 授权许可】

CC BY