Severe Pneumocystis carinii pneumonia produces a hyperdynamic profile similar to bacterial pneumonia with sepsis.

Abstract

To investigate the effects of Pneumocystis carinii on the cardiovascular system. To compare the hemodynamic data from patients with P. carinii pneumonia with those data from patients with bacterial pneumonia with sepsis. Retrospective, descriptive study of prospectively gathered hemodynamic and clinical data. Tertiary referral hospital, medical intensive care unit. Forty-one consecutive patients with severe P. carinii pneumonia and 31 patients with bacterial pneumonia who had invasive hemodynamic monitoring for management of hypotension and/or hypoxemia. On initial presentation, both groups had a hyperdynamic hemodynamic profile that included tachycardia, an increased cardiac index, and a low systemic vascular resistance index. The mean heart rate of the P. carinii pneumonia patients (113 +/- 3 beats/min) was significantly lower than that of the patients with bacterial pneumonia (126 +/- 4 beats/min). The cardiac index, systemic vascular resistance index, pulmonary vascular resistance index, and pulmonary artery pressures did not differ significantly between the two groups. The patients with bacterial pneumonia had a significantly lower mean left ventricular stroke volume index and stroke work index than the patients with P. carinii pneumonia. P. carinii can produce a hyperdynamic hemodynamic profile similar to that seen in patients with bacterial pneumonia with sepsis.