Prognostic evaluation by oxygenation with positive end‐expiratory pressure in acute exacerbation of idiopathic pulmonary fibrosis: A retrospective cohort study

Suzuki, Atsushi; Taniguchi, Hiroyuki; Ando, Masahiko; Kondoh, Yasuhiro; Kimura, Tomoki; Kataoka, Kensuke; Matsuda, Toshiaki; Yokoyama, Toshiki; Sakamoto, Koji; Hasegawa, Yoshinori

doi:10.1111/crj.12602

Cited by 17 publications

(15 citation statements)

References 30 publications

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“…Higher serum D‐dimer and lower PaO 2 /FiO 2 ratio at the time of diagnosis of AE were independent predictors of 90‐day mortality in AE‐ILD. Previous studies have shown the prognostic utility of these variables using the data of AE‐IPF based on the 2007 definition . We now demonstrated the same results using the 2016 definition.…”

Section: Discussionsupporting

confidence: 81%

“…Idiopathic pulmonary fibrosis (IPF) is a progressive and devastating disease with a median survival time (MST) of 3–4 years after diagnosis . The majority of patients with IPF demonstrate a gradual worsening over years, but a significant minority of patients experience episodes of acute respiratory worsening, termed acute exacerbation (AE) . In 2016, an international working group revised the definition and diagnostic criteria for AE‐IPF .…”

Section: Introductionmentioning

confidence: 99%

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Acute exacerbations of fibrotic interstitial lung diseases

et al. 2019

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Background and objective: Acute exacerbation (AE) is a severe complication of idiopathic pulmonary fibrosis (AE-IPF). In 2016, an international working group revised its definition and diagnostic criteria; however, few studies have assessed the frequency and prognosis of AE in patients with other fibrotic interstitial lung diseases (FILD). Methods: We used data from 1019 consecutive interstitial lung disease (ILD) patients initially evaluated between January 2008 and July 2015. All subject diagnoses were made by multidisciplinary discussion in December 2018. ILD was categorized as IPF (n = 462) and other FILD which included non-specific interstitial pneumonia (n = 22), chronic hypersensitivity pneumonitis (n = 29), connective tissue disease-associated ILD (n = 205) and unclassifiable ILD (n = 209). Using the 2016 definition of AE-IPF, we identified all subjects with an AE. Results: During the observational period, 193 patients experienced a first AE (AE-FILD n = 69, AE-IPF n = 124). The time to first AE was significantly longer in FILD than IPF (log-rank test, P < 0.001). After adjusting for potentially influential confounders, FILD remained a significant predictor of longer time to first AE compared with IPF (hazard ratio: 0.453; 95% CI: 0.317-0.647, P = 0.006). In a multivariate Cox proportional analysis, baseline disease severity was closely associated with the incidence of AE-ILD. Even after adjustment for other clinical variables, AE had a negative impact on overall survival. AE-FILD and AE-IPF showed similar poor short-term outcomes. Conclusion: All forms of ILD are at risk of AE and have a similar outcome to AE-IPF. SUMMARY AT A GLANCEThis study reveals that all forms of fibrotic interstitial lung diseases (FILD) are at risk of acute exacerbations (AE) and have similar outcomes to AE of idiopathic pulmonary fibrosis (AE-IPF). Clinicians are recommended to consider all forms of FILD to be at risk of AE.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Acute exacerbations of fibrotic interstitial lung diseases

et al. 2019

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“…This is because the molecular weight of SP‐D is less than that of KL‐6, and SP‐D in alveolar spaces might flow into the blood stream more easily and thus better reflect AE‐IIPs disease activity than KL‐6. However, the prognostic significance of serum KL‐6 for AE‐IPF has also been previously reported …”

Section: Discussionmentioning

confidence: 93%

“…However, the prognostic significance of serum KL-6 for AE-IPF has also been previously reported. 36,37 There are some limitations in this study. First, this is a retrospective study conducted at a single institute.…”

Section: Discussionmentioning

confidence: 96%

High‐dose prednisolone after intravenous methylprednisolone improves prognosis of acute exacerbation in idiopathic interstitial pneumonias

et al. 2017

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“…For IPF patients suffering from hypoxic respiratory failure, HFNC is a non-invasive approach to relieve hypoxia and permit physical activity. Patients in whom HFNC is insufficient may benefit from invasive mechanical ventilation through recruitment of atelectatic lung and improved ventilation-perfusion matching (46). However, mechanical ventilation in IPF patients is not without risk.…”

Section: Pulmonary Arterial Hypertensionmentioning

confidence: 99%

Contemporary approaches in the use of extracorporeal membrane oxygenation to support patients waiting for lung transplantation

Keller

2020

Ann Cardiothorac Surg

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The introduction of the lung allocation score in 2005 prioritized patients with decreased transplant-free survival as the recipients of donor organs and effectively increased the number of critically-ill patients with end-stage lung disease waiting for transplantation. This change presented transplant programs with the challenge of how to both extend the lives of critically-ill, end-stage lung disease patients waiting for donor organs and maintain patient vitality to survival through the rigors of surgery and post-transplant recovery. Motivated by the dismal outcomes of patients maintained on mechanical ventilation pre-transplant, transplant centers increasingly deploy extracorporeal membrane oxygenation (ECMO) as a means of supporting patients with advanced disease as a bridge to successful lung transplantation. ECMO is an extracorporeal gas exchange device providing delivery of oxygen and removal of carbon dioxide from blood passed through the circuit. The specific cannulation strategy determines whether ECMO provides primarily respiratory or circulatory support. The cannulation approach is tailored to the specific physiological manifestations of the pre-lung transplant candidate's disease process. For patients with profound hypoxic respiratory failure, a cannulation strategy that captures a large fraction of the venous return is required to maintain adequate support whereas lower circuit flows are sufficient for patients with predominantly hypercapnic respiratory failure. Improving outcomes and increasing experience with ECMO is motivating transplant centers to initiate support before patients require mechanical ventilation. Awake cannulation is increasingly common and is used to avoid the complications associated with intubation in advanced lung failure. Determining criteria for initiation of support and identifying the optimal approach to support patients with right heart failure in need of circulatory support are avenues of active investigation. Use of ECMO and other forms of extracorporeal support are rapidly becoming a mainstay in the care of the prelung transplant patient with advanced disease.

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Prognostic evaluation by oxygenation with positive end‐expiratory pressure in acute exacerbation of idiopathic pulmonary fibrosis: A retrospective cohort study

Abstract: Evaluation of oxygenation with PEEP may provide useful information for predicting short-term mortality in patients with AE-IPF.

Cited by 17 publications

References 30 publications

Acute exacerbations of fibrotic interstitial lung diseases

Acute exacerbations of fibrotic interstitial lung diseases

High‐dose prednisolone after intravenous methylprednisolone improves prognosis of acute exacerbation in idiopathic interstitial pneumonias

Contemporary approaches in the use of extracorporeal membrane oxygenation to support patients waiting for lung transplantation

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