U K Misra1, J Kalita2, S Betai1, S K Bhoi1. 1. Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Science, Raebareily Rd, Lucknow. 2. Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Science, Raebareily Rd, Lucknow. Electronic address: jayanteek@yahoo.com.
Abstract
PURPOSE: There is paucity of information about the outcome of tuberculous meningitis (TBM) patients on mechanical ventilation (MV). In this communication, we report the clinical characteristics, predictors of MV, and outcome of TBM patients requiring MV. METHOD: Thirty-eight (18%) of 205 patients with TBM requiring MV were included; and their demographic, clinical, cerebrospinal fluid, and magnetic resonance imaging finding at admission and follow-up were noted. The ventilator-related and systemic complications, hospital death, and 3-month functional outcome were noted. The predictors of need of MV were derived by multivariate regression analysis. RESULTS: There were 38 MV and 36 non-MV TBM patients who were matched for age, sex, and stage of meningitis on admission. The requirement of MV was independently related to leukocytosis, seizure, and cerebrospinal fluid pleocytosis on admission. Patients on MV had higher frequency of septicemia (9 vs 2), bedsores (6 vs 0), and gastric hemorrhage (4 vs 0) compared with non-MV patients. Only 29% of MV patients survived and had poor outcome at 3 months; but in the non-MV group, all the patients survived, and only 11% had poor outcome. CONCLUSION: Mechanical ventilation was needed in 18% TBM patients because of TBM-related or systemic complications. Those requiring MV had high mortality and may be categorized separately.
PURPOSE: There is paucity of information about the outcome of tuberculous meningitis (TBM) patients on mechanical ventilation (MV). In this communication, we report the clinical characteristics, predictors of MV, and outcome of TBM patients requiring MV. METHOD: Thirty-eight (18%) of 205 patients with TBM requiring MV were included; and their demographic, clinical, cerebrospinal fluid, and magnetic resonance imaging finding at admission and follow-up were noted. The ventilator-related and systemic complications, hospital death, and 3-month functional outcome were noted. The predictors of need of MV were derived by multivariate regression analysis. RESULTS: There were 38 MV and 36 non-MV TBM patients who were matched for age, sex, and stage of meningitis on admission. The requirement of MV was independently related to leukocytosis, seizure, and cerebrospinal fluid pleocytosis on admission. Patients on MV had higher frequency of septicemia (9 vs 2), bedsores (6 vs 0), and gastric hemorrhage (4 vs 0) compared with non-MV patients. Only 29% of MV patients survived and had poor outcome at 3 months; but in the non-MV group, all the patients survived, and only 11% had poor outcome. CONCLUSION: Mechanical ventilation was needed in 18% TBM patients because of TBM-related or systemic complications. Those requiring MV had high mortality and may be categorized separately.
Authors: Jayantee Kalita; Usha K Misra; Varun K Singh; Prakash C Pandey; Justin Thomas Journal: Am J Trop Med Hyg Date: 2020-05-21 Impact factor: 2.345
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