Management of children with tuberculosis admitted to a pediatric intensive care unit

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Abstract
To review the incidence, clinical features, ventilatory support and outcome of children with tuberculosis (TB) admitted to a Pediatric Intensive Care Unit (PICU) in a region with an high incidence of TB. The study was performed in a PICU situated in a province with a extremely high incidence of TB (>700 new cases/100 000/year). This is a retrospective descriptive study of TB admissions to the PICU in a 4-year period. Data regarding indications for admission, clinical picture, duration of ventilation, PICU and hospital stay were collected from patient files. Outcome measures included mortality and long term morbidity. Of the 1862 children admitted to the hospital for TB during the 4 years, 57 (3.1%) required PICU admission (1 to 6% of annual admissions). Of these 57 children 41 (72%) were admitted for respiratory failure. In 12 cases TB was the cause of the respiratory failure, 17 cases suffered from other respiratory diseases and in 12 cases the cause was nonrespiratory disease of which TB meningitis (n = 8) was the most common. Mechanical ventilation was indicated in 43 (75%) patients who were ventilated for 7.3 ± 11.5 days. The duration of PICU admission was 10.2 ± 2.4 days whereas the duration of hospitalization was 70.3 ± 148.9 days. The PICU mortality was 23% with TB meningitis having the highest mortality of 75%. In a region with a high incidence of TB, tuberculous patients constitute up to 6% of PICU admissions. A high degree of suspicion for the diagnosis is needed because in 30% of our cases the diagnosis was not initially considered.