Acute Respiratory Failure in Critically Ill Patients with Interstitial Lung Disease

Abstract

BackgroundPatients with chronic known or unknown interstitial lung disease (ILD) may present with severe respiratory flares that require intensive management. Outcome data in these patients are scarce.Patients and MethodsClinical and radiological features were collected in 83 patients with ILD-associated acute respiratory failure (ARF). Determinants of hospital mortality and response to corticosteroid therapy were identified by logistic regression.ResultsHospital and 1-year mortality rates were 41% and 54% respectively. Pulmonary hypertension, computed tomography (CT) fibrosis and acute kidney injury were independently associated with mortality (odds ratio (OR) 4.55; 95% confidence interval (95%CI) (1.20–17.33); OR, 7.68; (1.78–33.22) and OR 10.60; (2.25–49.97) respectively). Response to steroids was higher in patients with shorter time from hospital admission to corticosteroid therapy. Patients with fibrosis on CT had lower response to steroids (OR, 0.03; (0.005–0.21)). In mechanically ventilated patients, overdistension induced by high PEEP settings was associated with CT fibrosis and hospital mortality.ConclusionMortality is high in ILD-associated ARF. CT and echocardiography are valuable prognostic tools. Prompt corticosteroid therapy may improve survival.

Critically Ill Patients with Interstitial Lung Disease

“…77 That being said, none of the patients in this study required treatment with vasoactive agents directed toward the pulmonary vasculature. 77 Other suspicious medications (a list can be found at www.pneumotox.com) ventricular failure not caused by left ventricular dysfunction, pharmacologic agents directed toward the pulmonary vasculature can be considered if refractory to volume management and oxygen supplementation, although this is not evidence-based 75 and is not reported in the literature.…”

Acute respiratory distress syndrome mimickers lacking common risk factors of the Berlin definition

“…Altogether, these findings suggest that ARDS CRF-patients, who exhibit a high mortality, may have better outcomes when cytological or radiological signs suggestive of lung lesions potentially responding to therapy with anti-inflammatory agents are present. Last, as was recently shown, the early acquisition of a chest CT scan allows for predicting a poor outcome when lung fibrosis is present [27]. In contrast, in typical ARDS cases (i.e., ARDS CRF?…”

Bronchoscopy assessment of acute respiratory failure in interstitial lung disease

“…AE has been recognized as a frequent cause of death and decompensation in IPF patients, with a mortality ranging from 60% to100% . Occurrence of AE in patients with ILD other than IPF has also been described and associated with high morbidity and mortality . Bronchoscopy is recommended as a means to exclude secondary causes, particularly in those on immunosuppressive therapy with potential opportunistic infection and related alveolar haemorrhage .…”

“…Acute exacerbation (AE) is a specifically recognized form of respiratory failure associated with significant morbidity and death in idiopathic pulmonary fibrosis (IPF) patients . AE has also been described in other idiopathic and secondary ILDs, such as idiopathic non‐specific interstitial pneumonia (iNSIP) or connective tissue disease‐associated ILD (CTD‐ILD) . Prior diagnosis of AE required exclusion of secondary causes such as infection, pulmonary embolism (PE), heart failure or diffuse alveolar haemorrhage (DAH) …”