High-flow nasal cannula oxygen therapy for acute exacerbation of interstitial pneumonia: A case series

Horio, Yukihiro; Takihara, Takahisa; Niimi, Kyoko; Komatsu, Masamichi; Sato, Mariko; Tanaka, Jun; Takiguchi, Hiroto; Tomomatsu, Hiromi; Tomomatsu, Katsuyoshi; Hayama, Naoki; Oguma, Tsuyoshi; Aoki, Takuya; Urano, Tetsuya; Takagi, Atsushi; Asano, Koichiro

doi:10.1016/j.resinv.2015.09.005

Cited by 23 publications

(15 citation statements)

References 20 publications

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“…Therefore, this observation needs to be evaluated in large studies, as it is unexpected. Research in high flow nasal cannula has been proposed to be an alternative to conventional oxygen to correct hypoxaemia in patients with IPF [50] but the evidence is limited to series of cases on patients with interstitial pneumonias [51] and patients with do-not-intubate orders [52].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for mortality and mortality rates in interstitial lung disease patients in the intensive care unit

et al. 2018

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Data on interstitial lung disease (ILD) outcomes in the intensive care unit (ICU) is of limited value due to population heterogeneity. The aim of this study was to examine risk factors for mortality and ILD mortality rates in the ICU.We performed a systematic review using five databases. 50 studies were identified and 34 were included: 17 studies on various aetiologies of ILD (mixed-ILD) and 17 on idiopathic pulmonary fibrosis (IPF). In mixed-ILD, elevated APACHE score, hypoxaemia and mechanical ventilation are risk factors for mortality. No increased mortality was found with steroid use. Evidence is inconclusive on advanced age. In IPF, evidence is inconclusive for all factors except mechanical ventilation and hypoxaemia. The overall in-hospital mortality was available in 15 studies on mixed-ILD (62% in 2001–2009 and 48% in 2010–2017) and 15 studies on IPF (79% in 1993–2004 and 65% in 2005–2017). Follow-up mortality rate at 1 year ranged between 53% and 100%.Irrespective of ILD aetiology, mechanical ventilation is associated with increased mortality. For mixed-ILD, hypoxaemia and APACHE scores are also associated with increased mortality. IPF has the highest mortality rate among ILDs, but since 1993 the rate appears to be declining. Despite improving in-hospital survival, overall mortality remains high.

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Section: Discussionmentioning

confidence: 99%

Risk factors for mortality and mortality rates in interstitial lung disease patients in the intensive care unit

et al. 2018

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“…For example, mechanical ventilation can be used as a bridge to lung transplant in eligible patients [17,69]. An alternative approach is to use nasal cannula oxygen, either conventional or high-flow, which is suggested by a small number of studies to potentially support breathing and avoid the need for intubation/mechanical ventilation [70][71][72]. Use of noninvasive ventilation may also be considered [73,74].…”

Section: Management Of Aementioning

confidence: 99%

Acute exacerbations of progressive-fibrosing interstitial lung diseases

et al. 2018

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Acute exacerbation of interstitial lung disease (ILD) is associated with a poor prognosis and high mortality. Numerous studies have documented acute exacerbation in idiopathic pulmonary fibrosis (IPF), but less is known about these events in other ILDs that may present a progressive-fibrosing phenotype. We propose defining acute exacerbation as an acute, clinically significant respiratory deterioration, typically less than 1 month in duration, together with computerised tomography imaging showing new bilateral glass opacity and/or consolidation superimposed on a background pattern consistent with fibrosing ILDs. Drawing on observations in IPF, it is suspected that epithelial injury or proliferation and autoimmunity are risk factors for acute exacerbation in ILDs that may present a progressive-fibrosing phenotype, but further studies are required. Current acute exacerbation management strategies are based on recommendations in IPF, but no randomised controlled trials of acute exacerbation management have been performed. Although there are no formal strategies to prevent the development of acute exacerbation, possible approaches include antifibrotic drugs (such as nintedanib and pirfenidone), and minimising exposure to infection, airborne irritants and pollutants. This review discusses the current knowledge of acute exacerbation of ILDs that may present a progressive-fibrosing phenotype and acknowledges limitations of the data available.

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“…To date, we are not aware of any randomized trial evaluating the effects of HFNO in patients with AE-IPF. Only a case series by Horio et al [ 60 ] showed that, when used in IPF patients during AE, HFNO is well tolerated and associated with increased ventilation efficiency, decreased respiratory rate, and reduced work of breathing. However, the potential effectiveness of HFNO should be carefully assessed in this specific subset of hypoxic patients with particular reference to the potential enhancement of fibrotic damage in the lungs following long-term exposure to high concentrations of oxygen.…”

Section: Respiratory Assistancementioning

confidence: 99%

Acute exacerbation of idiopathic pulmonary fibrosis: lessons learned from acute respiratory distress syndrome?

et al. 2018

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Idiopathic pulmonary fibrosis (IPF) is a fibrotic lung disease characterized by progressive loss of lung function and poor prognosis. The so-called acute exacerbation of IPF (AE-IPF) may lead to severe hypoxemia requiring mechanical ventilation in the intensive care unit (ICU). AE-IPF shares several pathophysiological features with acute respiratory distress syndrome (ARDS), a very severe condition commonly treated in this setting.A review of the literature has been conducted to underline similarities and differences in the management of patients with AE-IPF and ARDS.During AE-IPF, diffuse alveolar damage and massive loss of aeration occurs, similar to what is observed in patients with ARDS. Differently from ARDS, no studies have yet concluded on the optimal ventilatory strategy and management in AE-IPF patients admitted to the ICU. Notwithstanding, a protective ventilation strategy with low tidal volume and low driving pressure could be recommended similarly to ARDS. The beneficial effect of high levels of positive end-expiratory pressure and prone positioning has still to be elucidated in AE-IPF patients, as well as the precise role of other types of respiratory assistance (e.g., extracorporeal membrane oxygenation) or innovative therapies (e.g., polymyxin-B direct hemoperfusion). The use of systemic drugs such as steroids or immunosuppressive agents in AE-IPF is controversial and potentially associated with an increased risk of serious adverse reactions.Common pathophysiological abnormalities and similar clinical needs suggest translating to AE-IPF the lessons learned from the management of ARDS patients. Studies focused on specific therapeutic strategies during AE-IPF are warranted.

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High-flow nasal cannula oxygen therapy for acute exacerbation of interstitial pneumonia: A case series

Cited by 23 publications

References 20 publications

Risk factors for mortality and mortality rates in interstitial lung disease patients in the intensive care unit

Risk factors for mortality and mortality rates in interstitial lung disease patients in the intensive care unit

Acute exacerbations of progressive-fibrosing interstitial lung diseases

Acute exacerbation of idiopathic pulmonary fibrosis: lessons learned from acute respiratory distress syndrome?

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