Mechanical ventilation in patients with end-stage idiopathic pulmonary fibrosis.
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.
Mollica
Corrado
C
Respiratory Intermediate Intensive Care Unit, S. Camillo-Forlanini Hospital, Rome, Italy.
Paone
Gregorino
G
Conti
Vittoria
V
Ceccarelli
Daniela
D
Schmid
Giovanni
G
Mattia
Paolo
P
Perrone
Nicola
N
Petroianni
Angelo
A
Sebastiani
Alfredo
A
Cecchini
Luca
L
Orsetti
Remo
R
Terzano
Claudio
C
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