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Clinical review: Tuberculosis on the intensive care unit

Rates of tuberculosis (TB) are increasing in most west European nations. Patients with TB can be admitted to an ICU for a variety of reasons, including respiratory failure, multiorgan failure and decreased consciousness associated with central nervous system disease. TB is a treatable disease but th...

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Detalles Bibliográficos
Autores principales: Hagan, Guy, Nathani, Nazim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056111/
https://www.ncbi.nlm.nih.gov/pubmed/24093433
http://dx.doi.org/10.1186/cc12760
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author Hagan, Guy
Nathani, Nazim
author_facet Hagan, Guy
Nathani, Nazim
author_sort Hagan, Guy
collection PubMed
description Rates of tuberculosis (TB) are increasing in most west European nations. Patients with TB can be admitted to an ICU for a variety of reasons, including respiratory failure, multiorgan failure and decreased consciousness associated with central nervous system disease. TB is a treatable disease but the mortality for patients admitted with TB to an ICU remains high. Management challenges exist in establishing a prompt diagnosis and administering effective treatment on the ICU with potentially poor gastric absorption and high rates of organ dysfunction and drug toxicity. In this review reasons for ICU admission, methods of achieving a confident diagnosis through direct and inferred methods, anti-tuberculosis treatment (including steroid and other adjuvant therapies) and specific management problems with particular relevance to the intensivist are discussed. The role of therapeutic drug monitoring, judicious use of alternative regimes in the context of toxicity or organ dysfunction and when to suspect paradoxical tuberculosis reactions are also covered. Diagnostic and therapeutic algorithms are proposed to guide ICU doctors in the management of this sometimes complicated disease.
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spelling pubmed-40561112014-09-27 Clinical review: Tuberculosis on the intensive care unit Hagan, Guy Nathani, Nazim Crit Care Review Rates of tuberculosis (TB) are increasing in most west European nations. Patients with TB can be admitted to an ICU for a variety of reasons, including respiratory failure, multiorgan failure and decreased consciousness associated with central nervous system disease. TB is a treatable disease but the mortality for patients admitted with TB to an ICU remains high. Management challenges exist in establishing a prompt diagnosis and administering effective treatment on the ICU with potentially poor gastric absorption and high rates of organ dysfunction and drug toxicity. In this review reasons for ICU admission, methods of achieving a confident diagnosis through direct and inferred methods, anti-tuberculosis treatment (including steroid and other adjuvant therapies) and specific management problems with particular relevance to the intensivist are discussed. The role of therapeutic drug monitoring, judicious use of alternative regimes in the context of toxicity or organ dysfunction and when to suspect paradoxical tuberculosis reactions are also covered. Diagnostic and therapeutic algorithms are proposed to guide ICU doctors in the management of this sometimes complicated disease. BioMed Central 2013 2013-09-27 /pmc/articles/PMC4056111/ /pubmed/24093433 http://dx.doi.org/10.1186/cc12760 Text en Copyright © 2013 BioMed Central Ltd
spellingShingle Review
Hagan, Guy
Nathani, Nazim
Clinical review: Tuberculosis on the intensive care unit
title Clinical review: Tuberculosis on the intensive care unit
title_full Clinical review: Tuberculosis on the intensive care unit
title_fullStr Clinical review: Tuberculosis on the intensive care unit
title_full_unstemmed Clinical review: Tuberculosis on the intensive care unit
title_short Clinical review: Tuberculosis on the intensive care unit
title_sort clinical review: tuberculosis on the intensive care unit
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056111/
https://www.ncbi.nlm.nih.gov/pubmed/24093433
http://dx.doi.org/10.1186/cc12760
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