Ana Maheshwari

Characteristics and outcomes of HIV-1–infected patients with acute respiratory distress syndrome ☆ ☆☆

PURPOSE We determined the prevalence of risk factors for the development of acute respiratory distress syndrome (ARDS), outcomes of critical illness, and the impact of highly active antiretroviral therapy in HIV-1-infected patients. We hypothesized that in an urban county hospital, HIV-1-infected patients with ARDS would have a higher mortality than their HIV-1-uninfected counterparts. MATERIALS AND METHODS Subjects were enrolled between 2006 and 2012. Baseline patient demographics, comorbidities, illness severity, causes of ARDS, and clinical outcomes were obtained. The primary end point was hospital mortality. RESULTS A total of 178 subjects with ARDS were enrolled in the study; 40 (22%) were infected with HIV-1. The median CD4 count was 75 (15.3-198.3), and 25% were on highly active antiretroviral therapy. HIV-1-infected subjects were significantly younger (44 vs 52 years; P < .01) and had higher rates of asthma, chronic obstructive pulmonary disease, pneumonia, history of hospital-acquired infections, and prior sepsis. HIV-1-infected subjects had greater illness severity by Acute Physiology and Chronic Health Evaluation II scores (29 [24-31] vs 24 [22-25]; P < .01). Hospital mortality was not higher among HIV-1-infected subjects compared with HIV-1-uninfected subjects (50.0% vs 38.4%; P = .19). CONCLUSIONS In patients with ARDS, HIV-1 infection was associated with greater illness severity but was not associated with higher mortality in ARDS. Future studies need to be done to evaluate the factors that contribute to high morbidity and mortality in medically vulnerable populations who develop ARDS.

908: CRITICALLY ILL PATIENTS WITH TOBACCO DEPENDENCE REQUIRE LONGER INFUSION OF DEXMEDETOMIDINE

Learning Objectives: Smoking is one of the most common addictions in the world. It has proven to increase mortality and cause withdrawal when immediately stopped. We have previously shown that patients with alcohol dependence show improved outcomes on dexmedetomidine (DEX) in terms of intensive care unit (ICU) length of stay (LOS) and mortality. We hypothesize that smokers who required DEX, also have better outcomes, when compared to non-smokers in the ICU. Methods: A retrospective observational study was conducted from January 2014 to September 2015 in adult ICUs at two academic community hospitals in a large urban setting. All patients were on a DEX infusion (196) during their hospitalization (15 excluded based on exclusion criteria). Baseline patient demographics, comorbidities, and clinical characteristics were collected. Patients were split into two groups, smokers versus non-smokers. Clinical outcomes were compared using Chi-Squared and unpaired T-test. Results: 181 patients were included in final data analysis; mean age was 58.3, in a primarily male and African American population. Average APACHE II scores were 25.1 for smokers, and 26.4 for non-smokers. In our study, smokers had significant longer hours of infusion on DEX versus non-smokers, 48 hours versus 37 hours (p-value < 0.04, 95% CI 0.40 to 22). Interestingly, smokers on DEX did not have a longer hospital or ICU LOS. Smokers with a nicotine patch were compared with smokers without a patch, and there was no significant reduction in hours of infusion (p-value = 0.66), or ICU LOS (p-value = 0.82). Conclusions: Based on our study, the smoking population required longer duration of infusion when compared to the non-smoking population. We also concluded that smokers with a nicotine patch had no reduction in hours of duration, ICU or hospital LOS when compared with smokers without a patch. We conclude DEX has a role in suppressing nicotine withdrawal, by acting as an alpha-2 agonist to decrease sympathetic activity. Therefore, there is no added benefit of a nicotine patch on patients on a DEX infusion.