Noninvasive ventilation in the event of acute respiratory failure in patients with idiopathic pulmonary fibrosis.
BACKGROUND
Some patients with idiopathic pulmonary fibrosis (IPF) develop severe acute respiratory failure (ARF) requiring admission to an intensive care unit (ICU) and ventilatory support. A limited number of observational studies have reported that noninvasive ventilation (NIV) can be an effective treatment to support breathing and to prevent use of invasive mechanical ventilation in these patients. This study aimed to retrospectively investigate the clinical status and outcomes in IPF patients receiving NIV for ARF and to identify those clinical and laboratory characteristics, which could be considered risk factors for its failure.


METHODS
This is a retrospective analysis of short-term outcomes in 18 IPF patients being administered NIV for ARF. This study was conducted in a 4-bed respiratory ICU (RICU) in a university hospital. Eighteen IPF patients who were administered NIV between January 1, 2005, and April 30, 2013, were included. The outcome measures are the need for endotracheal intubation despite NIV treatment and mortality rate during their RICU stay. The length of the patients' stay in the RICU and their survival rate following RICU admission were also evaluated.


RESULTS
Noninvasive ventilation was successful in 8 patients and unsuccessful in 10 who required endotracheal intubation. All the patients in the NIV failure group died within 20.2±15.3 days of intubation. The patients in the NIV success group spent fewer days in the RICU (11.6±4.5 vs 24.6±13.7; P=.0146). The median survival time was significantly shorter for the patients in the NIV failure with respect to the success group (18.0 [95% confidence interval {CI}, 9.0-25.0] vs 90.0 [95% CI, 65.0-305.0] days; P<.0001); the survival rate at 90 days was, likewise, lower in the NIV failure group (0% vs 34%±19.5%). At admission, the patients in the failure group had significantly higher respiratory rate values (36.9±7.8 vs 30.5±3.3 breaths/min; P=.036), plasma N-terminal fragment of the prohormone of B-type natriuretic peptide (NT-proBNP) levels (4528.8±4012.8 vs 634.6±808.0 pg/mL; P=.023) and serum C-reactive protein values (72.0±50.0 vs 20.7±24.0 μg/mL; P=.0289) with respect to those in the success group. Noninvasive ventilation failure was correlated to the plasma NT-proBNP levels at RICU admission (P=.0326) with an odds ratio of 12.2 (95% CI, 1.2 to infinity) in the patients with abnormally high values (>900 pg/mL).


CONCLUSIONS
The outcome of IPF patients who were administered NIV was quite poor. The use of NIV was, nevertheless, found to be associated with clinical benefits in selected IPF patients, preventing the need for intubation and reducing the rate of complications/death. Elevated plasma NT-proBNP levels at the time of ICU admission is a simple clinical marker for poor NIV outcome.
Respiratory Intensive Care Unit, City Hospital of Padova, Padova, Italy. Electronic address: avianello@qubisoft.it.
Andrea
A
Vianello
Respiratory Intensive Care Unit, City Hospital of Padova, Padova, Italy.
Giovanna
G
Arcaro
Respiratory Intensive Care Unit, City Hospital of Padova, Padova, Italy.
Laura
L
Battistella
Department of Formative Sciences, University of Modena and Reggio Emilia, Modena, Italy.
Emanuela
E
Pipitone
Department of Radiology, University of Padova, Padova, Italy.
Stefania
S
Vio
Respiratory Intensive Care Unit, City Hospital of Padova, Padova, Italy.
Alessandra
A
Concas
Respiratory Intensive Care Unit, City Hospital of Padova, Padova, Italy.
Luciana
L
Paladini
Respiratory Intensive Care Unit, City Hospital of Padova, Padova, Italy.
Federico
F
Gallan
Respiratory Intensive Care Unit, City Hospital of Padova, Padova, Italy.
Maria Rita
MR
Marchi
Department of Cardiology, University of Padova, Padova, Italy.
Francesco
F
Tona
Department of Cardiology, University of Padova, Padova, Italy.
Sabino
S
Iliceto
D000368:Aged; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications*; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000628:therapy; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D056152:Respiratory Rate; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
Acute respiratory failure; Idiopathic Pulmonary Fibrosis; Noninvasive Ventilation