title: Mechanical ventilation in patients with end-stage idiopathic pulmonary fibrosis.
abstract: BACKGROUND
  Acute respiratory failure (ARF) occurring during idiopathic pulmonary fibrosis (IPF) is associated with a poor prognosis. In this subset of individuals, mechanical ventilation (MV) may be required.
  
  
  OBJECTIVE
  We analysed the characteristics of a group of IPF patients undergoing MV for ARF in order to give some indications on the supposed prognosis.
  
  
  METHODS
  Hospital records of 34 consecutive patients with IPF, who underwent MV for ARF, were retrospectively examined. Demographic data, time from diagnosis, gas exchange, Acute Physiology and Chronic Health Evaluation (APACHE) II score, ARF causes and MV failure were recorded.
  
  
  RESULTS
  Fifteen subjects (group A) underwent invasive MV and 19 patients (group B) non-invasive ventilation (NIV). The 2 groups were different for disease severity (APACHE II score 24.2 +/- 6 vs. 19.5 +/- 5.9; p = 0.01). Both ventilatory strategies temporarily increased PaO2/FiO2 as compared with spontaneous breathing (group A: 148.5 +/- 52 vs. 99 +/- 39, p = 0.0004; group B: 134 +/- 36 vs. 89 +/- 26, p = 0.0004). NIV reduced the respiratory rate (26 +/- 7 vs. 36 +/- 9 with spontaneous breathing; p = 0.002). Duration of MV correlated with the time of evolution of IPF (r = 0.45; p = 0.018). The in-hospital mortality rate was 85% (100% for invasive MV, 74% for NIV). Four of the 5 survivors died within 6 months from hospital discharge (range 2-6 months).
  
  
  CONCLUSIONS
  MV does not appear to have a significant impact on the survival of patients with end-stage IPF. NIV may be useful for compassionate use, providing relief from dyspnoea and avoiding aggressive approaches.
authors: Respiratory Intermediate Intensive Care Unit, S. Camillo-Forlanini Hospital, Rome, Italy.
authors: Corrado
authors: C
authors: Mollica
authors: Gregorino
authors: G
authors: Paone
authors: Vittoria
authors: V
authors: Conti
authors: Daniela
authors: D
authors: Ceccarelli
authors: Giovanni
authors: G
authors: Schmid
authors: Paolo
authors: P
authors: Mattia
authors: Nicola
authors: N
authors: Perrone
authors: Angelo
authors: A
authors: Petroianni
authors: Alfredo
authors: A
authors: Sebastiani
authors: Luca
authors: L
authors: Cecchini
authors: Remo
authors: R
authors: Orsetti
authors: Claudio
authors: C
authors: Terzano
mesh_terms: D000368:Aged; D003422:Critical Care; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012384:Rome / Q000453:epidemiology