Role of non-invasive ventilation in managing life-threatening acute exacerbation of interstitial pneumonia.
BACKGROUND
Invasive mechanical ventilation (IMV) is not effective for acute exacerbation of interstitial pneumonia (AE-IP); however, the role of non-invasive ventilation (NIV) for this condition remains unknown.


METHODS
Comparisons were made for two periods: before (October 2001 - September 2003) and after (October 2004 - September 2006) the introduction of NIV as the primary method of mechanical ventilation for AE-IP. We retrospectively screened emergent admissions and enrolled consecutively those patients with AE-IP who had acutely worsening hypoxemia with new infiltrates, background chronic interstitial CT changes, and no findings suggestive of other diseases. The two periods were compared primarily for 60-day survival and secondarily for other outcomes associated with mechanical ventilation.


RESULTS
Medical records were retrieved for 11 episodes in 11 patients identified from 485 pre-NIV records and 27 episodes in 22 patients from 859 post-NIV records. Five patients required IMV in the earlier cohort and 9 patients received NIV in the later cohort. Although there was no difference in the PaO(2)/FiO(2) ratio on admission (167 vs. 139), the 60-day survival rate for all episodes in the later cohort was better than in the earlier cohort (27% vs. 65%, p=0.02). Moreover, the NIV-administered group had a better 60-day survival rate (0% vs. 44%, p=0.03), shorter high-care unit stay (17 vs. 6 days, p=0.03) and better-preserved verbal communication (0 vs., 89%) than the IMV-administered group.


CONCLUSIONS
Use of NIV in place of IMV for the management of life-threatening AE-IP appears to result in a better 60-day survival rate, lower high-care unit use and better patient tolerability.
Tomii
Keisuke
K
Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan. ktomii@kcgh.gr.jp
Tachikawa
Ryo
R
Chin
Kazuo
K
Murase
Kimihiko
K
Handa
Tomohiro
T
Mishima
Michiaki
M
Ishihara
Kyosuke
K
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends