Non-invasive mechanical ventilation in patients with diffuse interstitial lung diseases

Abstract

BackgroundTo evaluate noninvasive ventilation (NIV) in diffuse interstitial lung diseases (DILD) patients with acute respiratory failure (ARF) according to baseline radiological patterns and the etiology of ARF.MethodsIn a multicenter, observational, retrospective study, consecutive DILD patients undergoing NIV because of an episode of ARF were evaluated in six Italian high dependency units. Three groups of patients were identified based on the etiology of ARF: those with pneumonia (Group A), those with acute exacerbation of fibrosis, (Group B) and those with other triggers (Group C). Clinical failure was defined as any among in-hospital mortality, endotracheal intubation and extra-corporeal membrane oxygenation use.ResultsAmong the 60 patients enrolled (63% males; median age: 71 years), pneumonia (42%) and acute exacerbation of fibrosis (39%) were the two most frequent causes of ARF. A significant increase of PaO2/FiO2 ratio during NIV treatment was detected in Group A (p = 0.010), but not in Group B. No significant difference in PaO2/FiO2 ratio, PaCO2 and pH values during NIV treatment was detected in patients with a radiological pattern of usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP). 22 patients (37%) suffered for a clinical failure. No significant differences in the study outcome were detected in Group A vs. Group B, as well as among patients with a radiological pattern of UIP vs. NSIP.ConclusionsNIV treatment should be individualized in DILD patients with ARF according to the etiology, but not the baseline radiological pattern, in order to improve oxygenation.

Acute and subacute idiopathic interstitial pneumonias

“…Therefore, non‐invasive ventilation (NIV) is expected to be effective for acute and subacute IIP because of reductions in both endotracheal intubation and ventilator associated pneumonia. Although there are no randomized controlled studies to support the beneficial effect of NIV for acute/subacute IPs, several studies suggest its efficacy compared with the poor outcomes of patients with invasive mechanical ventilation in previous studies (Table ). It also was reported that early initiation of NIV and low severity of patient condition were associated with survival.…”

Acute Respiratory Failure in Interstitial Lung Disease Complicated by Pulmonary Hypertension

“…Pulse steroids and immunosuppressive agents have been suggested for ILD exacerbations, particularly showing benefit in NSIP [85]. The use of glucocorticoids is controversial during septic shock states and may be beneficial in combination with mineralocorticoids [68]. Short term steroid use has been described to improve diuresis during heart failure exacerbations [86,87].…”

ERS International Congress, Madrid, 2019: highlights from the Respiratory Intensive Care Assembly

“…NIV and HFNC are scarcely explored and should not delay intubation. NIV probably retains more risks than benefits [99], and P-SILI (see above) is possible also with HFNC.…”