Lung and chest wall mechanics in ventilated patients with end stage idiopathic pulmonary fibrosis

Nava, Stefano; Rubini, F

doi:10.1136/thx.54.5.390

Cited by 118 publications

(100 citation statements)

References 28 publications

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“…22 Fernández-Pérez and co-workers also showed a poor outcome with high PEEP, as it may overinflate relatively intact lung units. It also has no effect on fibrotic, unrecruitable regions, and thus promotes ventilator interaction lung injury in patients with ILDs.…”

Section: Discussionmentioning

confidence: 97%

Why Do Patients With Interstitial Lung Diseases Fail in the ICU? A 2-Center Cohort Study

et al. 2013

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BACKGROUND: Admitting patients with interstitial lung disease (ILD) to the ICU is controversial, due to their associated high mortality when they require invasive mechanical ventilation. We aimed to determine the risk factors for mortality in ILD patients requiring ICU support due to acute respiratory failure. METHODS: An observational cohort study was performed in 2 chest diseases teaching hospitals. We included all ILD patients with acute respiratory failure admitted between 2008 and 2010. Subject demographics, noninvasive ventilation (NIV) and invasive ventilation use, and mortality were obtained from medical records. Subjects receiving NIV were divided based on their continuous or non-continuous demand for NIV. NIV failure was defined as intubation for invasive ventilation, or death during NIV. Cox regression analysis was used to determine the hazard ratio for NIV failure. RESULTS: We enrolled 120 subjects: 71 male, median age 66 years. The types of ILD were idiopathic pulmonary fibrosis (n ‫؍‬ 96), collagen vascular disease (n ‫؍‬ 10), silicosis (n ‫؍‬ 9), drug induced (n ‫؍‬ 3), and eosinophilic pneumonia (n ‫؍‬ 2). The median (IQR) Acute Physiology and Chronic Health Evaluation (APACHE II) score was 24 (19 -31), and 75 (62.5%) subjects received NIV on ICU admission, 47 (62.7%) of whom needed continuous NIV. The NIV failure rate was 49.3% (n ‫؍‬ 37). The mortality rates of continuous NIV, non-continuous NIV, invasive ventilation, and total ICU were 61.7% (29/47), 10.7% (3/28), 89.7% (61/68), 60% (72/120), respectively. APACHE II > 20 and continuous NIV demand indicated significant risk for NIV failure: hazard ratio 2.77 (95% CI 1.19 -6.45), P < .02, and 5.12, (1.44 -18.19), P < .01, respectively. CONCLUSIONS: Because of higher mortality, physicians should consider invasive ventilation cautiously in the ICU management of ILD patients with acute respiratory failure. NIV may be an option in less severely ill patients with APACHE II score < 20.

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Section: Discussionmentioning

confidence: 97%

Why Do Patients With Interstitial Lung Diseases Fail in the ICU? A 2-Center Cohort Study

et al. 2013

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“…A study of seven patients with IPF receiving mechanical ventilation found that the elastance and the resistance of the respiratory system was markedly increased and correlated with the degree of hypercapnia. These phenomena may contribute to the observed absence of respiratory improvement in this patient group [36].…”

Section: Ventilationmentioning

confidence: 82%

“…In the period 1980-2000, a group of studies highlighted the inadequacy of mechanical ventilation in acute respiratory failure in IPF. Pooled data showed an aggregated mortality of 87% (118 out of 135), and short-term mortality (within 3 months of hospital discharge) of 94% [27,[32][33][34][35][36][37][38]. A study of seven patients with IPF receiving mechanical ventilation found that the elastance and the resistance of the respiratory system was markedly increased and correlated with the degree of hypercapnia.…”

Section: Ventilationmentioning

confidence: 99%

Follow-up and nonpharmacological management of the idiopathic pulmonary fibrosis patient

Egan¹

2011

Eur Respir Rev

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Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fatal form of diffuse interstitial lung disease. Management of IPF requires an orderly approach, with regular evaluations and implementation of both pharmacological and nonpharmacological treatments. Pulmonary rehabilitation can relieve patients from the distressing symptoms of IPF and improve quality of life. Oxygen therapy is central to treatment of all patients. Lung transplantation enhances survival in selected patients. Mechanical ventilation may be used in patients with acute exacerbations, but the prognosis is poor in these cases. Palliative care focuses on symptom management, advance directives and end-of-life planning. Patient support groups may also play an important role.KEYWORDS: Idiopathic pulmonary fibrosis, lung allocation score, lung transplantation, oxygen therapy, palliative care, pulmonary rehabilitation I diopathic pulmonary fibrosis (IPF) is a chronic, progressive, fatal form of diffuse interstitial lung disease which is associated with substantial mortality and morbidity [1,2]. It accounts for nearly 30% of lung transplantation procedures performed worldwide [3]. The disease is usually characterised by gradual onset of symptoms, with dyspnoea being the most prominent and the most disabling [4]. Risk factors associated with disease development include smoking, drug exposure, chronic aspiration, infectious agents and genetic predisposition [1].The management of IPF requires a methodical approach with regular evaluations and the implementation of both pharmacological and nonpharmacological treatment strategies. Potential pharmacotherapy includes corticosteroids, immunosuppressive agents and/or antifibrotic agents [1]. Thus, it is important to consider what nonpharmacological interventions are available that might allow patients with IPF to optimise their quality of life [5]. REHABILITATIONPulmonary rehabilitation has become the standard of care for chronic lung disease because of its effectiveness in alleviating symptoms, reducing the duration of hospital stays, increasing exercise tolerance and maximising functional ability [6,7]. Exercise rehabilitation has also been associated with positive psychosocial outcomes, including reduced symptoms of anxiety and depression [8].Pulmonary rehabilitation in IPF has been associated with a statistically significant improvement in 6-min walk distance and dyspnoea [9], although the role of maintenance exercise programmes following the initial structured training remains unclear [10]. Patients should be educated with regard to the treatment and prevention of infections [11]. Patients undergoing lung transplantation are required to participate in preoperative and postoperative pulmonary rehabilitation. The programmes help physicians to select appropriate surgical candidates, and also prepare patients physically and psychologically for the stress of surgery [10].Successful pulmonary rehabilitation may require behavioural changes on the part of the patient, including: weight loss, adopti...

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“…Some studies also discuss the importance of these measures in patients with pulmonar fibrosis (21) or with the human immunodeficiency virus (HIV) and pneumonia (22).…”

Section: Resultsmentioning

confidence: 99%

“…In pulmonary fibrosis, the low (C RS ) is associated with hypoventilation and hypercapnia (21,26). In individuals with HIV and pneumonia, changes in lung mechanics are similar to patients with ARDS, i.e., low (C RS ) and (C RS ) (22).…”

Section: Resultsmentioning

confidence: 99%

Comparison of respiratory mechanics measurements in the volume cycled ventilation (VCV) and pressure controlled ventilation (PCV)

et al. 2016

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Introduction: Monitoring respiratory mechanics may provide important information for the intensivist, assisting in the early detection of pulmonary function changes of patients hospitalized in ICU. Objective: To compare measurements of respiratory mechanics in VCV and PCV modes, and correlate them with age and oxygenation index. Materials and methods: Cross-sectional study conducted in the adult ICU of the Hospital Nossa Senhora da Conceição, in Tubarão -SC. A hundred and twenty individuals were selected between March and August 2013. The respiratory mechanics measurements were evaluated using compliance and resistance static measures of the respiratory system in PCV and VCV modes between the 1st and 5th day of hospitalization. Simultaneously, the oxygenation index PaO2/FiO2 was collected. Results: The obtained results were: compliance (VCV) = 40.9 ± 12.8 mL/cmH2O, compliance (PCV) = 35.0 ± 10.0 mL/cmH2O, resistance (VCV) = 13.2 ± 4.9 cmH2O/L/s, resistance (PCV) = 27.3 ± 16.2 cmH2O/L/s and PaO2/FiO2 = 236.0

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Lung and chest wall mechanics in ventilated patients with end stage idiopathic pulmonary fibrosis

Cited by 118 publications

References 28 publications

Why Do Patients With Interstitial Lung Diseases Fail in the ICU? A 2-Center Cohort Study

Why Do Patients With Interstitial Lung Diseases Fail in the ICU? A 2-Center Cohort Study

Follow-up and nonpharmacological management of the idiopathic pulmonary fibrosis patient

Comparison of respiratory mechanics measurements in the volume cycled ventilation (VCV) and pressure controlled ventilation (PCV)

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