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VOLUME 25 , ISSUE S2 ( May, 2021 ) > List of Articles

INVITED ARTICLE

Tuberculosis in Intensive Care Unit

Dhruva Chaudhry, Diksha Tyagi

Keywords : Acute respiratory distress syndrome (ARDS), Miliary tuberculosis, Septic shock, Tuberculous meningitis

Citation Information :

DOI: 10.5005/jp-journals-10071-23872

License: CC BY-NC 4.0

Published Online: 01-05-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

About 3.4% of the hospitalized tubercular patients need admission to the intensive care unit (ICU). Patients requiring ICU admission had a poor prognosis and high mortality rate (60 vs 25%) as compared to other causes of severe pneumonia. The most common indication for tuberculosis-related ICU admission is acute respiratory failure due to pneumonia or acute respiratory distress syndrome (ARDS) (with or without miliary tuberculosis) followed by septic shock with multiple organ dysfunction, adrenal insufficiency, and neurological involvement, especially tubercular meningitis. Tuberculosis patients who require admission to ICU are mostly immunocompromised [human immunodeficiency virus (HIV) coinfection] and have underlying miliary tuberculosis or disseminated tuberculosis. Pulmonary tuberculosis presenting as ARDS is a rare phenomenon, but a most common cause of admission of tuberculosis patients to ICU. Tuberculous meningitis is the most severe form of tuberculosis with mortality more than 60% and residual neurological disability in 25% cases. Tuberculosis-related septic shock has been found in only 1% of all septic shock patients admitted to ICU. Patients with tuberculosis with refractory shock should be suspected for adrenal insufficiency. A trial of physiologic stress replacement dose of hydrocortisone (200–300 mg) should be given to all critically ill patients with vasopressor-dependent shock after correcting other causes. Diagnosis and treatment of tuberculosis in critically ill patients has various challenges, namely appropriate sample collection, issues with the route of administration, drug absorption, bioavailability, dose modification in hepatic and renal dysfunction, and interaction with other drugs.


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  1. WHO Global Report; 2020. Available from: www.who.int/tb/publications/global_report/en/.
  2. Muthu V, Agarwal R, Dhooria S, Aggarwal AN, Behera D, Sehgal IS. Outcome of critically ill subjects with tuberculosis: systematic review and meta-analysis. Respir Care 2018;63(12):1541–1554. DOI: 10.4187/respcare.06190.
  3. Muthu V, Dhooria S, Agarwal R, Prasad KT, Aggarwal AN, Behera D, et al. Profile of patients with active tuberculosis admitted to a Respiratory Intensive Care Unit in a Tertiary Care Center of North India. Indian J Crit Care Med 2018;22(2):63–66. DOI: 10.4103/ijccm.IJCCM_491_17.
  4. Erbes R, Oettel K, Raffenberg M, Mauch H, Schmidt-Ioanas M, Lode H. Characteristics and outcome of patients with active pulmonary tuberculosis requiring intensive care. Eur Respir J 2006;27(6):1223–1228. DOI: 10.1183/09031936.06.00088105.
  5. Penner C, Roberts D, Kunimoto D, Manfreda J, Long R. Tuberculosis as a primary cause of respiratory failure requiring mechanical ventilation. Am J Respir Crit Care Med 1995;151(3 Pt 1):867–872. DOI: 10.1164/ajrccm/151.3_Pt_1.867.
  6. Agarwal R, Gupta D, Aggarwal AN, Behera D, Jindal SK. Experience with ARDS caused by tuberculosis in a respiratory intensive care unit. Intensive Care Med 2005;31(9):1284–1287. DOI: 10.1007/s00134-005-2721-2.
  7. The ARDS Definition Task Force. Acute respiratory distress syndrome, the Berlin definition. JAMA 2012;307(23):2526–2533. DOI: 10.1001/jama.2012.5669.
  8. Erdem H, Ozturk-Engin D, Tireli H, Kilicoglu G, Defres S, Gulsun S, et al. Hamsi scoring in the prediction of unfavorable outcomes from tuberculous meningitis: results of Haydarpasa-II study. J Neurol 2015;262(4):890–898. DOI: 10.1007/s00415-015-7651-5.
  9. Heemskerk AD, Bang ND, Mai NT, Chau TT, Phu NH, Loc PP, et al. Intensified antituberculosis therapy in adults with tuberculous meningitis. N Engl J Med 2016;374(2):124–134. DOI: 10.1056/NEJMoa1507062.
  10. Silva DR, Menegotto DM, Schulz LF, Gazzana MB, Dalcin PT. Mortality among patients with tuberculosis requiring intensive care: a retrospective cohort study. BMC Infect Dis 2010;10:54. DOI: 10.1186/1471-2334-10-54.
  11. Zahar JR, Azoulay E, Klement E, De Lassence, Lucet JC, Regnier B, et al. Delayed treatment contributes to mortality in ICU patients with severe active pulmonary tuberculosis and acute respiratory failure. Intensive Care Med 2001;27(3):513–520. DOI: 10.1007/s001340000849.
  12. Rickard AC, Smith JE, Newell P, Bailey A, Kehoe A, Mann C. Salt or sugar for your injured brain? A metaanalysis of randomised controlled trials of mannitol versus hypertonic sodium solutions to manage raised intracranial pressure in traumatic brain injury. Emerg Med J 2014;31(8):679–683. DOI: 10.1136/emermed-2013-202679.
  13. Prasad K, Singh MB, Ryan H. Corticosteroids for managing tuberculous meningitis. Cochrane Database Syst Rev 2016;4(4):CD002244. DOI: 10.1002/14651858.CD002244.pub4.
  14. Wilkinson RJ, Rohlwink U, Misra UK, van Crevel R, Mai NTH, Dooley KE, et al. Tuberculous Meningitis International Research Consortium. Tuberculous meningitis. Nat Rev Neurol 2017;13(10):581–598. DOI: 10.1038/nrneurol.2017.120.
  15. Thao LTP, Heemskerk AD, Geskus RB, Mai NTH, Ha DTM, Chau TTH, et al. Prognostic models for 9-month mortality in tuberculous meningitis. Clin Infect Dis 2018;66(4):523–532. DOI: 10.1093/cid/cix849.
  16. Heemskerk AD, Nguyen MTH, Dang HTM, Vinh Nguyen CV, Nguyen LH, Do TDA, et al. Clinical outcomes of patients with drug-resistant tuberculous meningitis treated with an intensified antituberculosis regimen. Clin Infect Dis 2017;65(1):20–28. DOI: 10.1093/cid/cix230.
  17. Kethireddy S, Light RB, Mirzanejad Y, Maki D, Arabi Y, Lapinsky S, et al. Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Group. Mycobacterium tuberculosis septic shock. Chest 2013;144(2):474–482. DOI: 10.1378/chest.12-1286.
  18. Yamamoto R, Nahara I, Toyosaki M, Fukuda T, Masuda Y, Fujishima S. Hydrocortisone with fludrocortisone for septic shock: a systematic review and meta-analysis. Acute Med Surg 2020;7(1):e563. DOI: 10.1002/ams2.563.
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