• Comorbidity
• Intensive care unit
• Microbiology
• Outcome
• Severe community-acquired pneumonia

• Humans
• Community-Acquired Infections/epidemiology
• Community-Acquired Infections/mortality
• Community-Acquired Infections/microbiology
• South Africa/epidemiology
• Retrospective Studies
• Middle Aged
• Male
• Female
• Adult
• Pneumonia/epidemiology
• Pneumonia/mortality
• Pneumonia/microbiology
• Tertiary Care Centers
• Severity of Illness Index
• HIV Infections/complications
• HIV Infections/epidemiology
• Respiration, Artificial/statistics & numerical data
• Intensive Care Units/statistics & numerical data
• Coinfection/epidemiology
• Hospital Mortality

• Antituberculous treatment
• Critically ill
• Immunocompromised host
• Infection prevention and control
• Organ support
• Tuberculosis

• Critical care
• Diagnosis of tuberculosis
• Intensive care
• Management of tuberculosis
• Mycobaterium tuberculosis
• Severe tuberculosis
• Tuberculosis

• Humans
• Critical Illness/mortality
• Tuberculosis/mortality
• Respiration, Artificial
• Intensive Care Units/statistics & numerical data
• Risk Factors
• Length of Stay/statistics & numerical data
• Age Factors
• C-Reactive Protein/analysis

• ICU mortality
• NTM-LD
• Tuberculosis
• Ventilator-free survival

• Humans
• Aged
• Critical Illness
• Mycobacterium Infections, Nontuberculous/complications
• Pneumonia/complications
• Tuberculosis/complications
• Respiratory Insufficiency
• Ventilators, Mechanical
• Retrospective Studies
• Nontuberculous Mycobacteria

• ARDS
• Adolescent
• ICU
• Tuberculosis
• Xpert MTB/RIF

• Adult
• Adolescent
• Humans
• Child
• Mycobacterium tuberculosis
• Rifampin
• Antibiotics, Antitubercular/therapeutic use
• Sensitivity and Specificity
• Tuberculosis/complications
• Tuberculosis/epidemiology
• Tuberculosis/drug therapy
• Intensive Care Units

• Humans
• Middle Aged
• Fatigue/etiology
• Weight Loss
• Multiple Pulmonary Nodules/diagnostic imaging
• Multiple Pulmonary Nodules/etiology

• tuberculosis
• respiration, artificial
• respiratory insufficiency
• glucocorticoid
• critical care

Although studies have described the clinical profile of patients admitted to the intensive care unit (ICU) with tuberculosis, it is unclear if the type of tuberculosis (pulmonary, extrapulmonary, or disseminated) impacts outcome.

Demographic data, microbiology, treatment, and outcomes over 5 years (2012–16) were obtained from electronic records. Patients were categorized as pulmonary, extrapulmonary, or disseminated tuberculosis. Comparisons were done using t test and Fisher's exact test as appropriate. Predictors of outcome were explored using bivariate and multivariate logistic regression analysis and expressed as odds ratio (OR) with 95% confidence intervals (CI).

Of the 428 ICU admissions with suspected tuberculosis, 212 (121 male) patients with mean (standard deviation) age of 41.9 (16.7) years and APACHE-II score of 20.8 (6.6) were diagnosed as pulmonary (n = 55) and extrapulmonary (n = 52) or disseminated tuberculosis (n = 105). In 50.5%, the diagnosis of tuberculosis was established during the current ICU admission when they presented with organ dysfunction. Overall, microbiological confirmation was possible in 75.5%; 14 (10.3%) isolates were Rifampicin resistant. ICU admission was required primarily for ventilation (n = 176; 83%) and hemodynamic instability (n = 67; 32%). Hospital mortality was 50%. Outcomes were similar in the three groups except for longer duration of stay (p value = 0.04) in disseminated tuberculosis. On multivariate logistic regression analysis, pulmonary tuberculosis (OR 2.83; 95% CI 1.15–6.95) and vasoactive treatment (OR 15.8; 95% CI 6.4–39.2) were independently associated with death; need for ventilation predicted mortality perfectly.

In this cohort of patients admitted to ICU with tuberculosis, 50% were newly diagnosed during ICU admission. Pulmonary site of involvement and need for organ support are independent risk factors for death.

Thomas L, Chacko B, Jupudi S, Mathuram A, George T, Gunasekaran K, et al. Clinical Profile and Outcome of Critically Ill Patients with Tuberculosis. Indian J Crit Care Med 2021;25(1):21–28.

• Critically ill patients
• Gene Xpert
• Mortality
• Tuberculosis

The prognostic factor for in-hospital mortality in tuberculosis (TB) patients requiring intensive care unit (ICU) care remains unclear. Therefore, a retrospective study was conducted aiming to estimate the in-hospital mortality rate and the risk factors for mortality in a high-burden setting. All patients with culture-confirmed TB that were admitted to the ICU of the hospital between March 2012 and April 2019 were identified retrospectively. Data, such as demographic characteristics, comorbidities, laboratory measures and mortality, were obtained from medical records. The Cox proportional hazards regression model was used to identify prognostic factors that influence in-hospital mortality. A total of 82 ICU patients with confirmed TB were included in the analysis, and 22 deaths were observed during the hospital stay, 21 patients died in the ICU. In the multivariable model adjusted for sex and age, the levels of serum albumin and white blood cell (WBC) count were significantly associated with mortality in TB patients requiring ICU care (all P < 0.01), the hazard ratios were 0.8 (95% confidence interval (CI): 0.7–0.9) per 1 g/l and 1.1 (95% CI: 1.0–1.2) per 1 × 10⁹/l, respectively. In conclusion, in-hospital mortality remains high in TB patients requiring ICU care. Low serum albumin level and high WBC count significantly impact the risk of mortality in these TB patients in China.

• Death
• hazard ratio
• intensive care unit
• prognostic factor
• tuberculosis

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.

• Acute respiratory distress syndrome (ARDS)
• Miliary tuberculosis
• Septic shock
• Tuberculous meningitis

Tuberculosis (TB) continues to be a major cause of death worldwide and can have varying manifestations. Acute respiratory distress syndrome (ARDS) is a rare complication of the clinical course of TB but carries a high mortality rate. We present a case of a diabetic African-American patient, with acute respiratory failure, rapidly progressing to ARDS secondary to TB, which had a fatal outcome. Clinicians should keep a high suspicion index for TB in the setting of ARDS since the use of empiric anti-TB treatment could potentially reduce mortality in these patients.

Tuberculosis (TB) is a common infection that can affect the lungs. Acute respiratory distress syndrome rarely occurs with TB but carries a high mortality. Early treatment is important because it can reduce mortality. We present a case of TB complicated by acute respiratory distress syndrome, which had an extremely poor outcome.

• ARDS
• HFOV
• Pott disease
• intratracheal surfactant
• miliary tuberculosis
• nebulized DNAase