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. 2021 May;25(Suppl 2):S150-S154.
doi: 10.5005/jp-journals-10071-23872.

Tuberculosis in Intensive Care Unit

Dhruva Chaudhry  1 , Diksha Tyagi  1
Affiliations

Tuberculosis in Intensive Care Unit

Dhruva Chaudhry et al. Indian J Crit Care Med. 2021 May.

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. How to cite this article: Chaudhry D, Tyagi D. Tuberculosis in Intensive Care Unit. Indian J Crit Care Med 2021;25(Suppl 2):S150-S154.

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

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Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Fig. 1
Fig. 1
Chest radiograph showing bilateral diffuse infiltrates in a patient with tuberculosis-related ARDS
Fig. 2
Fig. 2
Computed tomography of the chest of a patient with tuberculosis-related ARDS showing multiple nodular opacities with diffuse ground-glass opacities
Fig. 3
Fig. 3
Ultrasonographic measurement of optic nerve sheath diameter for the evaluation of intracranial pressures in patients with tubercular meningitis
See this image and copyright information in PMC

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