title: Invasive mechanical ventilation in patients with fibrosing interstitial pneumonia.
abstract: OBJECTIVE
  The prognosis of patients with idiopathic pulmonary fibrosis or fibrosing idiopathic nonspecific interstitial pneumonia undergoing invasive mechanical ventilation (MV) for acute respiratory failure is known to be poor. The issue of life support in these patients needs to be reconsidered in light of changes during the past decade in ventilator settings and in the management of acute exacerbation. We therefore aimed to reassess the prognosis of such patients.
  
  
  METHODS
  We retrospectively assessed the outcomes of all medical patients with idiopathic pulmonary fibrosis or fibrosing idiopathic nonspecific interstitial pneumonia who required invasive MV in 3 university hospitals in the Paris area from January 2002 to April 2009.
  
  
  RESULTS
  In total, 27 patients (mean age, 66 ± 12.8 years) required invasive MV in the intensive care unit: 8 (30%) were successfully weaned from MV, and 6 and 4 were discharged from the intensive care unit and the hospital, respectively. Survivals for patients who did not undergo lung transplant were 22%, 3.7%, and 3.7%, at 30 days, 6 months, and 12 months, respectively.
  
  
  CONCLUSIONS
  We confirm that use of invasive MV for acute respiratory failure in patients with idiopathic pulmonary fibrosis or fibrosing idiopathic nonspecific interstitial pneumonia is associated with a high mortality; however, a subset of patients may be discharged alive from the intensive care unit and hospital, providing an opportunity to consider lung transplant in case of eligibility. Our results suggest that invasive MV should not be systematically denied to these patients but discussed on a case-by-case basis.
authors: Service de Réanimation Médicale et des Maladies Infectieuses, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Denis Diderot, Paris, France. Electronic address: stephanegaudry@gmail.com.
authors: Stephane
authors: S
authors: Gaudry
authors: Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, Assistance Publique Hôpitaux de Paris, Bobigny, France.
authors: François
authors: F
authors: Vincent
authors: Service de Réanimation Respiratoire, Hôtel Dieu, Assistance Publique Hôpitaux de Paris, Paris, France.
authors: Antoine
authors: A
authors: Rabbat
authors: Service de Pneumologie, Hôpital Avicenne, Assistance Publique Hôpitaux de Paris, Bobigny, France.
authors: Hilario
authors: H
authors: Nunes
authors: Service de Pneumologie A, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Denis Diderot, Paris, France.
authors: Bruno
authors: B
authors: Crestani
authors: Service de Pneumologie, Hôpital Avicenne, Assistance Publique Hôpitaux de Paris, Bobigny, France.
authors: Jean Marc
authors: JM
authors: Naccache
authors: Service de Réanimation Médicale et des Maladies Infectieuses, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Denis Diderot, Paris, France.
authors: Michel
authors: M
authors: Wolff
authors: Service de Pneumologie B, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Denis Diderot, Paris, France.
authors: Gabriel
authors: G
authors: Thabut
authors: Service de Pneumologie, Hôpital Avicenne, Assistance Publique Hôpitaux de Paris, Bobigny, France.
authors: Dominique
authors: D
authors: Valeyre
authors: Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, Assistance Publique Hôpitaux de Paris, Bobigny, France.
authors: Yves
authors: Y
authors: Cohen
authors: Service de Pneumologie B, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Denis Diderot, Paris, France.
authors: Hervé
authors: H
authors: Mal
mesh_terms: D000208:Acute Disease; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D054988:Idiopathic Interstitial Pneumonias / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D054990:Idiopathic Pulmonary Fibrosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010297:Paris; D010351:Patient Discharge; D018579:Patient Selection; D012121:Respiration, Artificial / Q000009:adverse effects / Q000401:mortality; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: 11.3; 12; 21; 41.4; ARF; BAL; ECMO; ICU; IPF; LTx; MV; Vt; acute respiratory failure; bronchoalveolar lavage; extracorporeal membrane oxygenation; iNSIP; idiopathic nonspecific interstitial pneumonia; idiopathic pulmonary fibrosis; intensive care unit; lung transplant; mechanical ventilation; tidal volume