Características clínicas y pronóstico de los pacientes con fibrosis pulmonar que ingresan en cuidados intensivos por insuficiencia respiratoria. Análisis de 20 casos

Molina-Molina, María; Badia, Joan R.; Marín-Arguedas, Alejandra; Xaubet, Antoni; Santos, María José; Nicolás, José M.; Ferrer, Miguel; Torres, Antoni

doi:10.1157/13048922

Cited by 5 publications

(4 citation statements)

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“…Consistent with this observation and according to the literature [2,3,4,5,6,7], in our study, ARF was characterized by a rapid worsening of gas exchange with severe hypoxaemia, CO 2 retention and pH shift towards acidosis, associated with a deterioration of the mental status. Because of the severe alterations in lung mechanics, in order to maximize alveolar recruitment, high TV values are usually applied when performing conventional MV (iMV) in IPF patients [2,3,4,5,6,7,18]. …”

Section: Discussionsupporting

confidence: 93%

“…Although the clinical course is usually slowly progressive, some patients experience a rapid decline, and acute respiratory failure (ARF) can develop during the course of the disease. In this subset of subjects, mechanical ventilation (MV) may be required, although its effectiveness lacks consensus [2,3,4,5,6,7]. Recently, Suh and coworkers [8] reported that an early diagnostic and therapeutic approach including a ‘lung protective’ MV led to a favourable outcome in patients with ARF during acute interstitial pneumonia, renewing the discussion on MV effectiveness in IPF patients with ARF.…”

Section: Introductionmentioning

confidence: 99%

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Mechanical Ventilation in Patients with End-Stage Idiopathic Pulmonary Fibrosis

Mollica¹,

Paone

Conti

et al. 2009

Respiration

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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.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Mechanical Ventilation in Patients with End-Stage Idiopathic Pulmonary Fibrosis

Mollica¹,

Paone

Conti

et al. 2009

Respiration

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“…For human, fibrosis of the lung is correlated with respiratory failure and an increased risk of death [11,21]. Several postmortem reports on patients with H5NI influenza have demonstrated the presence of organizing diffuse alveolar damage with interstitial fibrosis [22].…”

Section: Discussionmentioning

confidence: 99%

“…Pathological findings show that 64% of ARDS patients may have pulmonary fibrosis (PF) during convalescence [10]. Owing to the damage of architecture and loss of functional capillary units of the lung, Idiopathic pulmonary fibrosis (IPF) in human can lead to respiratory failure within a few years following diagnostic confirmation, and may correlate with an increased risk of death [11]. PF results as a consequence of many types of severe lung injury and is almost always associated with an inflammatory reaction [12,13].…”

Section: Introductionmentioning

confidence: 99%

Pulmonary fibrosis induced by H5N1 viral infection in mice

Jian

Zhang

et al. 2009

Respir Res

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BackgroundInflammatory process results in lung injury that may lead to pulmonary fibrosis (PF). Here, we described PF in mice infected with H5N1 virus.MethodsEight-week-old BALB/c mice were inoculated intranasally with 1 × 101 MID50 of A/Chicken/Hebei/108/2002(H5N1) viruses. Lung injury/fibrosis was evaluated by observation of hydroxyproline concentrations, lung indexes, and histopathology on days 7, 14, and 30 postinoculation.ResultsH5N1-inoculated mice presented two stages of pulmonary disease over a 30-d period after infection. At acute stage, infected-mice showed typical diffuse pneumonia with inflammatory cellular infiltration, alveolar and interstitial edema and hemorrhage on day 7 postinoculation. At restoration stage, most infected-mice developed PF of different severities on day 30 postinoculation, and 18% of the survived mice underwent severe interstitial and intra-alveolar fibrosis with thickened alveolar walls, collapsed alveoli and large fibrotic areas. The dramatically elevated hydroxyproline levels in H5N1-infected mice showed deposition of collagen in lungs, and confirmed fibrosis of lungs. The dry lung-to-body weight ratio was significantly increased in infected group, which might be associated with the formation of PF in H5N1-infected mice.ConclusionOur findings show that H5N1-infected mice develop the typical PF during restoration period, which will contribute to the investigation of fibrogenesis and potential therapeutic intervention in human H5N1 disease.

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Prophylactic, therapeutic and immune enhancement effect of liposome‐encapsulated PolyICLC on highly pathogenic H5N1 influenza infection

Jin

et al. 2011

The Journal of Gene Medicine

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Características clínicas y pronóstico de los pacientes con fibrosis pulmonar que ingresan en cuidados intensivos por insuficiencia respiratoria. Análisis de 20 casos

Cited by 5 publications

References 0 publications

Mechanical Ventilation in Patients with End-Stage Idiopathic Pulmonary Fibrosis

Mechanical Ventilation in Patients with End-Stage Idiopathic Pulmonary Fibrosis

Pulmonary fibrosis induced by H5N1 viral infection in mice

Prophylactic, therapeutic and immune enhancement effect of liposome‐encapsulated PolyICLC on highly pathogenic H5N1 influenza infection

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