Management of acute respiratory failure in interstitial lung diseases: overview and clinical insights

Paola Faverio, Federica De Giacomi, Luca Sardella, Giuseppe Fiorentino, Mauro Carone, Francesco Salerno, Jousel Ora, Paola Rogliani, Giulia Pellegrino, Giuseppe Francesco Sferrazza Papa, Francesco Bini, Bruno Dino Bodini, Grazia Messinesi, Alberto Pesci, Antonio Esquinas

Research output: Contribution to journalReview article

Abstract

BACKGROUND: Interstitial lung diseases (ILDs) are a heterogeneous group of diseases characterized by widespread fibrotic and inflammatory abnormalities of the lung. Respiratory failure is a common complication in advanced stages or following acute worsening of the underlying disease. Aim of this review is to evaluate the current evidence in determining the best management of acute respiratory failure (ARF) in ILDs.

METHODS: A literature search was performed in the Medline/PubMed and EMBASE databases to identify studies that investigated the management of ARF in ILDs (the last search was conducted on November 2017).

RESULTS: In managing ARF, it is important to establish an adequate diagnostic and therapeutic management depending on whether the patient has an underlying known chronic ILD or ARF is presenting in an unknown or de novo ILD. In the first case both primary causes, such as acute exacerbations of the disease, and secondary causes, including concomitant pulmonary infections, fluid overload and pulmonary embolism need to be investigated. In the second case, a diagnostic work-up that includes investigations in regards to ILD etiology, such as autoimmune screening and bronchoalveolar lavage, should be performed, and possible concomitant causes of ARF have to be ruled out. Oxygen supplementation and ventilatory support need to be titrated according to the severity of ARF and patients' therapeutic options. High-Flow Nasal oxygen might potentially be an alternative to conventional oxygen therapy in patients requiring both high flows and high oxygen concentrations to correct hypoxemia and control dyspnea, however the evidence is still scarce. Neither Non-Invasive Ventilation (NIV) nor Invasive Mechanical Ventilation (IMV) seem to change the poor outcomes associated to advanced stages of ILDs. However, in selected patients, such as those with less severe ARF, a NIV trial might help in the early recognition of NIV-responder patients, who may present a better short-term prognosis. More invasive techniques, including IMV and Extracorporeal Membrane Oxygenation, should be limited to patients listed for lung transplant or with reversible causes of ARF.

CONCLUSIONS: Despite the overall poor prognosis of ARF in ILDs, a personalized approach may positively influence patients' management, possibly leading to improved outcomes. However, further studies are warranted.

Original languageEnglish
Pages (from-to)70
JournalBMC Pulmonary Medicine
Volume18
Issue number1
DOIs
Publication statusPublished - May 15 2018

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Interstitial Lung Diseases
Respiratory Insufficiency
Noninvasive Ventilation
Oxygen
Artificial Respiration
Lung
Extracorporeal Membrane Oxygenation
Bronchoalveolar Lavage
Acute Disease
Pulmonary Embolism
Nose
PubMed
Dyspnea
Therapeutics
Databases
Transplants

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Management of acute respiratory failure in interstitial lung diseases : overview and clinical insights. / Faverio, Paola; De Giacomi, Federica; Sardella, Luca; Fiorentino, Giuseppe; Carone, Mauro; Salerno, Francesco; Ora, Jousel; Rogliani, Paola; Pellegrino, Giulia; Sferrazza Papa, Giuseppe Francesco; Bini, Francesco; Bodini, Bruno Dino; Messinesi, Grazia; Pesci, Alberto; Esquinas, Antonio.

In: BMC Pulmonary Medicine, Vol. 18, No. 1, 15.05.2018, p. 70.

Research output: Contribution to journalReview article

Faverio, P, De Giacomi, F, Sardella, L, Fiorentino, G, Carone, M, Salerno, F, Ora, J, Rogliani, P, Pellegrino, G, Sferrazza Papa, GF, Bini, F, Bodini, BD, Messinesi, G, Pesci, A & Esquinas, A 2018, 'Management of acute respiratory failure in interstitial lung diseases: overview and clinical insights', BMC Pulmonary Medicine, vol. 18, no. 1, pp. 70. https://doi.org/10.1186/s12890-018-0643-3
Faverio, Paola ; De Giacomi, Federica ; Sardella, Luca ; Fiorentino, Giuseppe ; Carone, Mauro ; Salerno, Francesco ; Ora, Jousel ; Rogliani, Paola ; Pellegrino, Giulia ; Sferrazza Papa, Giuseppe Francesco ; Bini, Francesco ; Bodini, Bruno Dino ; Messinesi, Grazia ; Pesci, Alberto ; Esquinas, Antonio. / Management of acute respiratory failure in interstitial lung diseases : overview and clinical insights. In: BMC Pulmonary Medicine. 2018 ; Vol. 18, No. 1. pp. 70.
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author = "Paola Faverio and {De Giacomi}, Federica and Luca Sardella and Giuseppe Fiorentino and Mauro Carone and Francesco Salerno and Jousel Ora and Paola Rogliani and Giulia Pellegrino and {Sferrazza Papa}, {Giuseppe Francesco} and Francesco Bini and Bodini, {Bruno Dino} and Grazia Messinesi and Alberto Pesci and Antonio Esquinas",
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TY - JOUR

T1 - Management of acute respiratory failure in interstitial lung diseases

T2 - overview and clinical insights

AU - Faverio, Paola

AU - De Giacomi, Federica

AU - Sardella, Luca

AU - Fiorentino, Giuseppe

AU - Carone, Mauro

AU - Salerno, Francesco

AU - Ora, Jousel

AU - Rogliani, Paola

AU - Pellegrino, Giulia

AU - Sferrazza Papa, Giuseppe Francesco

AU - Bini, Francesco

AU - Bodini, Bruno Dino

AU - Messinesi, Grazia

AU - Pesci, Alberto

AU - Esquinas, Antonio

PY - 2018/5/15

Y1 - 2018/5/15

N2 - BACKGROUND: Interstitial lung diseases (ILDs) are a heterogeneous group of diseases characterized by widespread fibrotic and inflammatory abnormalities of the lung. Respiratory failure is a common complication in advanced stages or following acute worsening of the underlying disease. Aim of this review is to evaluate the current evidence in determining the best management of acute respiratory failure (ARF) in ILDs.METHODS: A literature search was performed in the Medline/PubMed and EMBASE databases to identify studies that investigated the management of ARF in ILDs (the last search was conducted on November 2017).RESULTS: In managing ARF, it is important to establish an adequate diagnostic and therapeutic management depending on whether the patient has an underlying known chronic ILD or ARF is presenting in an unknown or de novo ILD. In the first case both primary causes, such as acute exacerbations of the disease, and secondary causes, including concomitant pulmonary infections, fluid overload and pulmonary embolism need to be investigated. In the second case, a diagnostic work-up that includes investigations in regards to ILD etiology, such as autoimmune screening and bronchoalveolar lavage, should be performed, and possible concomitant causes of ARF have to be ruled out. Oxygen supplementation and ventilatory support need to be titrated according to the severity of ARF and patients' therapeutic options. High-Flow Nasal oxygen might potentially be an alternative to conventional oxygen therapy in patients requiring both high flows and high oxygen concentrations to correct hypoxemia and control dyspnea, however the evidence is still scarce. Neither Non-Invasive Ventilation (NIV) nor Invasive Mechanical Ventilation (IMV) seem to change the poor outcomes associated to advanced stages of ILDs. However, in selected patients, such as those with less severe ARF, a NIV trial might help in the early recognition of NIV-responder patients, who may present a better short-term prognosis. More invasive techniques, including IMV and Extracorporeal Membrane Oxygenation, should be limited to patients listed for lung transplant or with reversible causes of ARF.CONCLUSIONS: Despite the overall poor prognosis of ARF in ILDs, a personalized approach may positively influence patients' management, possibly leading to improved outcomes. However, further studies are warranted.

AB - BACKGROUND: Interstitial lung diseases (ILDs) are a heterogeneous group of diseases characterized by widespread fibrotic and inflammatory abnormalities of the lung. Respiratory failure is a common complication in advanced stages or following acute worsening of the underlying disease. Aim of this review is to evaluate the current evidence in determining the best management of acute respiratory failure (ARF) in ILDs.METHODS: A literature search was performed in the Medline/PubMed and EMBASE databases to identify studies that investigated the management of ARF in ILDs (the last search was conducted on November 2017).RESULTS: In managing ARF, it is important to establish an adequate diagnostic and therapeutic management depending on whether the patient has an underlying known chronic ILD or ARF is presenting in an unknown or de novo ILD. In the first case both primary causes, such as acute exacerbations of the disease, and secondary causes, including concomitant pulmonary infections, fluid overload and pulmonary embolism need to be investigated. In the second case, a diagnostic work-up that includes investigations in regards to ILD etiology, such as autoimmune screening and bronchoalveolar lavage, should be performed, and possible concomitant causes of ARF have to be ruled out. Oxygen supplementation and ventilatory support need to be titrated according to the severity of ARF and patients' therapeutic options. High-Flow Nasal oxygen might potentially be an alternative to conventional oxygen therapy in patients requiring both high flows and high oxygen concentrations to correct hypoxemia and control dyspnea, however the evidence is still scarce. Neither Non-Invasive Ventilation (NIV) nor Invasive Mechanical Ventilation (IMV) seem to change the poor outcomes associated to advanced stages of ILDs. However, in selected patients, such as those with less severe ARF, a NIV trial might help in the early recognition of NIV-responder patients, who may present a better short-term prognosis. More invasive techniques, including IMV and Extracorporeal Membrane Oxygenation, should be limited to patients listed for lung transplant or with reversible causes of ARF.CONCLUSIONS: Despite the overall poor prognosis of ARF in ILDs, a personalized approach may positively influence patients' management, possibly leading to improved outcomes. However, further studies are warranted.

U2 - 10.1186/s12890-018-0643-3

DO - 10.1186/s12890-018-0643-3

M3 - Review article

C2 - 29764401

VL - 18

SP - 70

JO - BMC Pulmonary Medicine

JF - BMC Pulmonary Medicine

SN - 1471-2466

IS - 1

ER -