Mechanical ventilation in idiopathic pulmonary fibrosis: a nationwide analysis of ventilator use, outcomes, and resource burden

Abstract

BackgroundIdiopathic pulmonary fibrosis (IPF) is associated with increased risk of respiratory-related hospitalizations. Studies suggest mechanical ventilation (MV) use in IPF does not improve outcomes and guidelines recommend against its general use. Our objective was to investigate MV use and association with cost and mortality in IPF.MethodsThis retrospective study, using a nationwide sample, included claims with IPF (ICD-9-CM: 516.3) in 2009–2011 and principal respiratory disease diagnosis (ICD-9-CM: 460–519); excluding lung transplant. Regression models were used to determine predictors of MV and association with cost, LOS, and mortality. Domain analysis was used to account for use of subpopulation. Costs were adjusted to 2011. Data on patient severity not available.ResultsTwenty two thousand three hundred fifty non-transplant IPF patients were admitted with principal respiratory disease diagnosis: Mean age 70.0 (SD 13.9), 49.1% female, mean LOS 7.4 (SD 8.2). MV was used in 11.4% of patients with a non-significant decline over time. In regression models, MV was associated with an increased stay of 9.78 days (95% CI 8.38–11.18) and increased cost of $36,583 (95% CI $32,021–41,147). MV users had significantly increased mortality (OR 15.55, 95% CI 12.13–19.95) versus nonusers.ConclusionsMechanical ventilation use has not significantly changed over time and is mostly used in younger patients and those admitted for non-IPF respiratory conditions. MV was associated with a 4-fold admission cost increase ($49,924 versus $11,742) and a 7-fold mortality increase (56% versus 7.5%), although patients who receive MV may differ from those who do not. Advances in treatment and decision aids are needed to improve outcomes in IPF.

In-hospital mortality trends among patients with idiopathic pulmonary fibrosis in the United States between 2013-2017: a comparison of academic and non-academic programs.

“…The mortality rate in IPF patients with respiratory failure receiving mechanical ventilation therapy has been reported to range from 50% to 90%. [2,29,34] Others reported mortality of 55.7% in intubated IPF patients between 2009 and 2011 using a different case de nition for IPF codes (ICD9, 516.3). [34]Another study showed declining mortality between 2006 and 2013 from 58.4% to 49.3% using the same database, but different case de nition.…”

“…[2,29,34] Others reported mortality of 55.7% in intubated IPF patients between 2009 and 2011 using a different case de nition for IPF codes (ICD9, 516.3). [34]Another study showed declining mortality between 2006 and 2013 from 58.4% to 49.3% using the same database, but different case de nition. [29] In our cohort, the decline in the respiratory failure associated mortality, mechanical ventilated associated mortality and mechanical ventilation therapy is likely multifactorial and might re ect evolving and increased adherence to evidencebased pharmacological and non-pharmacological management strategies.…”

Guidelines of the Polish Respiratory Society for Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis

“…Similarly, Gungor et al [379] demonstrated that the use of NIV in IPF and other ILDs is associated with a better overall prognosis, although a higher mortality rate was observed in patients requiring continuous NIV use. Retrospective studies indicate higher mortality in patients who have undergone invasive ventilation compared with those treated with NIV [380,381].…”

Acute Respiratory Failure in Interstitial Lung Disease Complicated by Pulmonary Hypertension

“…For comparison, the all-cause hospital mortality in a prospective cohort of 8151 ICU patients receiving IMV has been reported as 35% [77]. Mollica et al (2010) stated that all patients [65]. Smaller retrospective studies have suggested that NIPPV in ILD-ARF have reduced or no significant changes in mortality in comparison to IMV [5,66].…”

“…Smaller retrospective studies have suggested that NIPPV in ILD-ARF have reduced or no significant changes in mortality in comparison to IMV [5,66]. Larger studies have found significantly greater mortality amongst patients treated with IMV [65,78]. NIPPV should be considered prior to IMV and implemented with the avoidance of opioids or sedatives during treatment.…”