Mechanical ventilation in patients with end-stage idiopathic pulmonary fibrosis

Corrado Mollica, Gregorino Paone, Vittoria Conti, Daniela Ceccarelli, Giovanni Schmid, Paolo Mattia, Nicola Perrone, Angelo Petroianni, Alfredo Sebastiani, Luca Cecchini, Remo Orsetti, Claudio Terzano

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Abstract

Background: Acute respiratory failure (ARF) occurring during idiopathic pulmonary fibrosis (IPF) is associated with a poor prognosis. In this subset of individuals, mechanical ventilation (MV) may be required. Objectives: We analysed the characteristics of a group of IPF patients undergoing MV for ARF in order to give some indications on the supposed prognosis. Methods: Hospital records of 34 consecutive patients with IPF, who underwent MV for ARF, were retrospectively examined. Demographic data, time from diagnosis, gas exchange, Acute Physiology and Chronic Health Evaluation (APACHE) II score, ARF causes and MV failure were recorded. Results: Fifteen subjects (group A) underwent invasive MV and 19 patients (group B) non-invasive ventilation (NIV). The 2 groups were different for disease severity (APACHE II score 24.2 ± 6 vs. 19.5 ± 5.9; p = 0.01). Both ventilatory strategies temporarily increased PaO2/FiO2 as compared with spontaneous breathing (group A: 148.5 ± 52 vs. 99 ± 39, p = 0.0004; group B: 134 ± 36 vs. 89 ± 26, p = 0.0004). NIV reduced the respiratory rate (26 ± 7 vs. 36 ± 9 with spontaneous breathing; p = 0.002). Duration of MV correlated with the time of evolution of IPF (r = 0.45; p = 0.018). The in-hospital mortality rate was 85% (100% for invasive MV, 74% for NIV). Four of the 5 survivors died within 6 months from hospital discharge (range 2-6 months). Conclusions: MV does not appear to have a significant impact on the survival of patients with end-stage IPF. NIV may be useful for compassionate use, providing relief from dyspnoea and avoiding aggressive approaches.

Original languageEnglish
Pages (from-to)209-215
Number of pages7
JournalRespiration
Volume79
Issue number3
DOIs
Publication statusPublished - Jan 2010

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Keywords

  • Acute respiratory failure
  • Idiopathic pulmonary fibrosis
  • Invasive mechanical ventilation
  • Non-invasive mechanical ventilation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Mollica, C., Paone, G., Conti, V., Ceccarelli, D., Schmid, G., Mattia, P., Perrone, N., Petroianni, A., Sebastiani, A., Cecchini, L., Orsetti, R., & Terzano, C. (2010). Mechanical ventilation in patients with end-stage idiopathic pulmonary fibrosis. Respiration, 79(3), 209-215. https://doi.org/10.1159/000225932