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Prognostic factors and outcome of mechanically ventilated interstitial lung disease patients

Egyptian Journal of Bronchology volume 12, pages 226–232 (2018)Cite this article

Abstract

Background

The prognosis of mechanically ventilated interstitial lung disease (ILD) patients was controversial in previous studies. Identifying the factors associated with mortality could guide therapy and allow good use of ICU resources.

Aim

The aim was to study the outcome of ILD mechanically ventilated patients admitted to the respiratory ICU and to demonstrate the possible factors associated with mortality in these patients.

Patients and methods

The observational prospective study was carried out on ILD patients undergoing mechanical ventilation, either invasive mechanical ventilation (IMV) or noninvasive ventilation (NIV). Clinical, radiological, and outcome assessments were done for all enrolled patients. For outcome assessment, patients were classified into either survivors or nonsurvivors.

Results

Twenty-one (70%) of the patients were subjected to NIV, whereas nine (30%) of them were subjected to IMV. The overall mortality rate was 53.3%. However, the mortality rate was 35% in patients with NIV, but 100% in patients with IMV. Severity assessment scores were significantly higher in nonsurvivors compared with survivors. Nonsurvivors also presented significantly with lower pH and higher PaCO2 compared with survivors. Acute Physiology and Chronic Health Evaluation-II score greater than or equal to 18.5, Simplified Acute Physiology Score greater than or equal to 27.5, Glasgow coma scale score less than 12.5 and PaO2/ FiO2 less than 161.5 were associated with increased risk of mortality of ILD patients.

Conclusion

Mechanically ventilated ILD patients had a poor outcome. However, the survival rate of ILD patients was better on NIV than IMV. Severity assessment scores and PaO2/FiO2 could predict the risk of mortality in ILD patients.

References

  1. Wells AU, Hirani N, and on behalf of the BTS Group, a subgroup of the British Thoracic Society Standards of Care Committee, in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. Interstitial lung disease guideline. Thorax 2008;63:1–58.

    Google Scholar 

  2. Martinez FJ, Safrin S, Weycker D, Starko KM, Bradford WZ, King TE, et al. The clinical course of patients with idiopathic pulmonary fibrosis. Ann Intern Med 2005;142:963–967.

    PubMed  Google Scholar 

  3. Kim DS, Park JH, Park BK, Lee JS, Nicholson AG, Colby T. Acute exacerbation of idiopathic pulmonary fibrosis:frequency and clinical features. Eur Respir J 2006;27:143–150.

    CAS  PubMed  Google Scholar 

  4. Crowley SP, Kelly P, Egan JJ. Acute exacerbations in idiopathic pulmonary fibrosis. Ann Intern Med 2006;144:218–219.

    PubMed  Google Scholar 

  5. Collard HR, Moore BB, Flaherty KR, Brown KK, Kaner RJ, King TE, et al. Idiopathic pulmonary fibrosis clinical research network investigators:acute exacerbations of idiopathic pulmonary fi brosis. Am J Respir Crit Care Med 2007;176:636–643.

    PubMed  Google Scholar 

  6. Güngör G, Tatar D, Saltürk C, Çimen P, Karakurt Z, Kirakli C, et al. Why do patients with interstitial lung diseases fail in the ICU? A 2-center cohort study. Respir Care 2013;58:525–531.

    PubMed  Google Scholar 

  7. Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, Torres A. Noninvasive ventilation in severe hypoxemic respiratory failure:a randomized clinical trial. Am J Respir Crit Care Med 2003;168:1438–1444.

    PubMed  Google Scholar 

  8. Peros-Golubicic T, Sharma OP. Clinical atlas of interstitial lung disease. Springer Science & Business Media; 2006.

  9. Travis WD, Costabel U, Hansell DM, King TE Jr, Lynch DA, Nicholson AG, et al. An official American Thoracic Society/European Respiratory Society statement:update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 2013;188:733–748.

    PubMed  PubMed Central  Google Scholar 

  10. Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982;25:1271–1277.

    CAS  PubMed  Google Scholar 

  11. American Rheumatism Association Diagnostic and Therapeutic Criteria Subcommittee for Scleroderma. Criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee:preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 1980;23:581–590.

    Google Scholar 

  12. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315–324.

    CAS  PubMed  Google Scholar 

  13. Vitali C, Bombardieri S, Moutsopoulos HM, Coll J, Gerli R, Hatron PY, et al. Assessment of the European classification criteria for Sjögren’s syndrome in a series of clinically defined cases:results of a prospective multicentre study. The European Study Group on Diagnostic Criteria for Sjögren ’s syndrome. Ann Rheum Dis 1996;55:116–121.

    CAS  Google Scholar 

  14. Chuang TY, Hunder GG, Ilstrup DM, Kurland LT. Polymyalgia rheumatica:a 10-year epidemiologic and clinical study. Ann Intern Med 1982;97:672–680.

    CAS  PubMed  Google Scholar 

  15. Bohan A, Peter JB. Polymyositis and dermatomyositis. N Engl J Med 1975;292:344–407.

    CAS  PubMed  Google Scholar 

  16. Alarcon-Segovia D, Villarreal M. Classification and diagnostic criteria for mixed connective tissue diseases. In:Kasukava R, Sharp GC, editors. Mixed connective tissue diseases and anti-nuclear antibodies. Amsterdam:Elsevier 1987. 33–40

    Google Scholar 

  17. Smolen JS, Steiner G. Mixed connective tissue disease:to be or not to be? Arthritis Rheum 1998;41:768–777.

    CAS  PubMed  Google Scholar 

  18. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44:S27–S72.

    CAS  PubMed  Google Scholar 

  19. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. ACCF/AHA guideline for the management of heart failure:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;62:147–239.

    Google Scholar 

  20. Konstantinides S, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014;35:3033–3069.

    CAS  PubMed  Google Scholar 

  21. MacDuff A, Anthony A, John H. Management of spontaneous pneumothorax:British Thoracic Society pleural disease guideline2010. Thorax 2010;65:ii18–ii31.

    PubMed  Google Scholar 

  22. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II:a severity of disease classification system. Crit Care Med 1985;13:818–829.

    CAS  PubMed  Google Scholar 

  23. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707–710.

    CAS  PubMed  Google Scholar 

  24. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270:2957–2963.

    PubMed  Google Scholar 

  25. Iankova A. The Glasgow Coma Scale:clinical application in Emergency Departments. Emerg Nurse 2006;14:30–35.

    PubMed  Google Scholar 

  26. Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, et al. An official ATS/ERS/JRS/ALAT statement:idiopathic pulmonary fibrosis:evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011;183:788–824.

    PubMed  PubMed Central  Google Scholar 

  27. American Thoracic Society, European Respiratory Society, European Society of Intensive Care Medicine, Société de Réanimation de Langue Française. International Consensus Conference in Intensive Care Medicine:noninvasive positive pressure ventilation in acute respiratory failure. Approved by the ATS Board of Directors, December 2000. Am J Respir Crit Care Med 2001;163:283–291.

    Google Scholar 

  28. Carney D, Bagshaw S. Clinical characteristics and outcomes of patients with interstitial lung disease supported in intensive care. In C41. Outcomes of interstitial lung disease (pp. A4375-A4375). Am Thoracic Soc 2012; 185:A4375.

    Google Scholar 

  29. Stern JB, Mal H, Groussard O, Brugière O, Marceau A, Jebrak G, et al. Prognosis of patients with advanced idiopathic pulmo pulmonary fibrosis requiring mechanical ventilation for acute respiratory failure. Chest 2001;120:213–219.

    CAS  PubMed  Google Scholar 

  30. Yokoyama T, Kondoh Y, Taniguchi H, Kataoka K, Kato K, Nishiyama O, et al. Noninvasive ventilation in acute exacerbation of idiopathic pulmonary fibrosis. Intern Med 2010;49:1509–1514.

    PubMed  Google Scholar 

  31. Blivet SM, Philit FM, Sab JM, Langevin B, Paret M, Guérin C, et al. Outcome of patients with idiopathic pulmonary fibrosis admitted to the ICU for respiratory failure. Chest 2001;120:209–212.

    CAS  PubMed  Google Scholar 

  32. Saydain G, Islam A, Afessa B, Ryu JH, Scott JP, Peters SG. Outcome of patients with idiopathic pulmonary fibrosis admitted to the intensive care unit. Am J Respir Crit Care Med 2002;166:839–842.

    PubMed  Google Scholar 

  33. Rangappa P, Moran JL. Outcomes of patients admitted to the intensive care unit with idiopathic pulmonary fibrosis. Crit Care Resusc 2009; 11:102.

    PubMed  Google Scholar 

  34. Zafrani L, Lemiale V, Lapidus N, Lorillon G, Schlemmer B, Azoulay E. Acute respiratory failure in critically ill patients with interstitial lung disease. PLoS One 2014; 9:e104897.

    PubMed  PubMed Central  Google Scholar 

  35. Aliberti S, Messinesi G, Gamberini S, Maggiolini S, Visca D, Galavotti V, et al. Non-invasive mechanical ventilation in patients with diffuse interstitial lung diseases. BMC Pulm Med 2014; 14:194.

    PubMed  PubMed Central  Google Scholar 

  36. Tomii K, Tachikawa R, Chin K, Murase K, Handa T, Mishima M, et al. Role of non-invasive ventilation in managing life-threatening acute exacerbation of interstitial pneumonia. Intern Med 2010;49:1341–1347.

    PubMed  Google Scholar 

  37. Vianello A, Arcaro G, Battistella L, Pipitone E, Vio S, Concas A, et al. Noninvasive ventilation in the event of acute respiratory failure in patients with idiopathic pulmonary fibrosis. J Crit Care 2014;29:562–567.

    PubMed  Google Scholar 

  38. Fumeaux T, Rothmeier C, Jolliet P. Outcome of mechanical ventilation for acute respiratory failure in patients with pulmonary fibrosis. Intensive Care Med 2001;27:868–1874.

    Google Scholar 

  39. Stern JB, Mal H, Groussard O, Brugiere O, Marceau A, Jebrak G, et al. Prognosis of patients with advanced idiopathic pulmonary fibrosis requiring mechanical ventilation for acute respiratory failure. Chest 2001;120:213–219.

    CAS  PubMed  Google Scholar 

  40. Al-Hameed FM, Sharma S. Outcome of patients admitted to intensive care unit for acute exacerbation of idiopathic pulmonary fibrosis. Can Respir J 2004;11:117–122.

    PubMed  Google Scholar 

  41. Nava S, Rubini F. Lung and chest wall mechanics in ventilated patients with end stage idiopathic pulmonary fibrosis. Thorax 1999;54:390–395.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Vial-Dupuy A, Sanchez O, Douvry B, Guetta L, Juvin K, Wermert D, et al. Outcome of patients with interstitial lung diseases admitted to the intensive care unit. Sarcoidosis Vasc Diffuse Lung Dis 2013;30:134–142.

    CAS  PubMed  Google Scholar 

  43. Mollica C, Paone G, Conti V, Ceccarelli D, Schmid G, Mattia P, et al. Mechanical ventilation in patients with end-stage idiopathic pulmonary fibrosis. Respiration 2009;79:209–215.

    PubMed  Google Scholar 

  44. Le Gall JR. The use of severity scores in the intensive care unit. Intensive Care Med 2005;31:1618–1623.

    PubMed  Google Scholar 

  45. Zhou XY, Ben SQ, Chen HL, Ni SS. A comparison of APACHE II and CPIS scores for the prediction of 30-day mortality in patients with ventilator-associated pneumonia. Int J Infect Dis 2015;30:144–147.

    PubMed  Google Scholar 

  46. Ucgun I, Metintas M, Moral H, Alatas F, Yildirim H, Erginel S. Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU for acute hypercapnic respiratory failure. Respir Med 2006;100:66–74.

    PubMed  Google Scholar 

  47. Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA scores to predict outcome in critically ill patients. JAMA 2001;286:1754–1758.

    CAS  PubMed  Google Scholar 

  48. Pittet D, Thiévent B, Wenzel RP, et al. Bedside prediction of mortality from bacteremic sepsis. A dynamic analysis of ICU patients. Am J Respir Crit Care Med 1996;153:684–693.

    CAS  PubMed  Google Scholar 

  49. Molina-Molina M, Badia JR, Marín-Arguedas A, Xaubet A, Santos MJ, Nicolás JM, et al. Outcomes and clinical characteristics of patients with pulmonary fibrosis and respiratory failure admitted to an intensive care unit. A study of 20 cases. Med Clin (Barc) 2003;121:63–67.

    Google Scholar 

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Authors and Affiliations

  1. Chest Department, Faculty of Medicine, Assiut University Hospital, 7111, Assiut, Egypt

    Ashraf Zin El-Abdeen, Lamiaa H. Shaaban, Shereen Farghaly MD & Yara Y. Omar

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  1. Ashraf Zin El-Abdeen
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  2. Lamiaa H. Shaaban
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  3. Shereen Farghaly MD
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  4. Yara Y. Omar
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Correspondence to Shereen Farghaly MD.

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El-Abdeen, A.Z., Shaaban, L.H., Farghaly, S. et al. Prognostic factors and outcome of mechanically ventilated interstitial lung disease patients. Egypt J Bronchol 12, 226–232 (2018). https://doi.org/10.4103/ejb.ejb_101_17

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