Invasive mechanical ventilation in patients with fibrosing interstitial pneumonia

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 147; no. 1; pp. 47 - 53
• Main Authors: Gaudry, Stephane, MD, Vincent, François, MD, Rabbat, Antoine, MD, Nunes, Hilario, MD, PhD, Crestani, Bruno, MD, PhD, Naccache, Jean Marc, MD, Wolff, Michel, MD, PhD, Thabut, Gabriel, MD, PhD, Valeyre, Dominique, MD, PhD, Cohen, Yves, MD, PhD, Mal, Hervé, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 2014
• Subjects: Acute Disease; Aged; Cardiothoracic Surgery; Chi-Square Distribution; Female; Hospital Mortality; Hospitals, University; Humans; Idiopathic Interstitial Pneumonias - diagnosis; Idiopathic Interstitial Pneumonias - mortality; Idiopathic Interstitial Pneumonias - therapy; Idiopathic Pulmonary Fibrosis - diagnosis; Idiopathic Pulmonary Fibrosis - mortality; Idiopathic Pulmonary Fibrosis - therapy; Intensive Care Units; Kaplan-Meier Estimate; Length of Stay; Lung Transplantation; Male; Middle Aged; Paris; Patient Discharge; Patient Selection; Respiration, Artificial - adverse effects; Respiration, Artificial - mortality; Respiratory Insufficiency - diagnosis; Respiratory Insufficiency - mortality; Respiratory Insufficiency - therapy; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Paris; ECMO; 12; mechanical ventilation; lung transplant; MV; idiopathic pulmonary fibrosis; V t; BAL; LTx; 11.3; acute respiratory failure; ARF; iNSIP; idiopathic nonspecific interstitial pneumonia; extracorporeal membrane oxygenation; ICU; intensive care unit; 41.4; tidal volume; bronchoalveolar lavage; IPF; 21; Vt
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2013.06.039

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.