الفهرس 
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Abstract
Severe tuberculosis requiring intensive care unit care is rare but commonly known to be of bad prognosis. The acute respiratory failure due to pulmonary infections is a common cause for ICU admission. However, despite their high mortality rate, the TB-related critical conditions are rarely reported. Most studies on critical care TB cases were not conducted in high TB burden areas and were retrospective in nature.
This study aims to evaluate patients with active pulmonary TB admitted to intensive care unit at Abbassia Chest Hospital, to identify potential prognostic factors and determinants of mortality.
The study was a prospective observational study conducted on 51 patients with active pulmonary TB who required ICU admission for at least 24 h in ICU unit of Abbassia Chest Hospital during the period from January 1, 2018 till December 31, 2018. All patients were subjected to history and clinical examination, radiological and laboratory workup, and APACHI II score.
Patients were diagnosed and managed according to National TB Control Guidelines in Egypt. Hospital course, complications and ICU stay period were monitored and were correlated to the outcome.
In the current study there was no significant difference between patient outcome (death and discharge) and patient’s sex, smoking and drug addiction.
We included in our study patients with Active pulmonary TB diagnosed by either the following: Smear positive for acid-fast bacilli (AFB) for two sputum samples, Positive Gene Xpert MTB/RIF on sputum, Positive TB sputum culture, either solid (Lowenstein–Jensen medium) or liquid (The BD BACTEC MGIT; BD;
Becton, Dickinson and Company, Sparks, Maryland, Ireland), Histological pattern of TB granuloma on lung biopsy.
We excluded patients who stay at respiratory ICU for less than 24 hours, Extrapulmonary TB.
All patients included in this study were subjected to the following:
(a) Demographic data: name, age, sex, and special habits of medical importance (i.e. smoking and drug abuse).
(b) Clinical data:
(1) Reason for ICU admission.
(2) Presenting symptoms and signs.
(3) Comorbidities (hypertension, diabetes mellitus, HIV, and other chest diseases).
(4) Past medical history (i.e. old TB infection).
(5) Relevant medication use (anti-TB drugs).
(c) Case definition: new case, relapse, treatment after lost to follow-up (have previously been treated for TB and were declared lost to follow- up at the end of their most recent course of treatment), and treatment failure.
(d) Laboratory and related investigations:
Arterial blood gases (ABG), complete blood picture, serum sodium and potassium, liver and kidney functions, serum glucose level, coagulation profile (prothrombin time, partial thromboplastin time, and international normalized ratio).
(e) Acute Physiology and chronic Health Evaluation II (APACHE II)
score.
(f) Imaging
• Chest radiograph, posterior–anterior view.
• Computed tomography chest if needed.
(g) Management, course, and complications
(h) Antituberculous regimen [Cat-I/Cat II/ multi-drug resistance (MDR)]/anti- hepatotoxic − according to National TB Control Guidelines in Egypt [3].
(i) MDR-TB is known according to patient drug history and drug susceptibility test (Gene Xpert).
(j) Oxygen therapy.
Mean age of all studied patients was 42.9±16.4 years, 35 male (68.6%) and
16 females. There was statistically significant correlation between patient outcome, and APACHE II score, arterial blood gases, duration of mechanical ventilation and the total ICU stay in days respectively. ICU complications occurred in 72.5% of patients and they were significantly correlated with patient outcome