Outcomes and Mortality Prediction Model of Critically Ill Adults With Acute Respiratory Failure and Interstitial Lung Disease

Abstract Background: Generally, the incidence of irreversible lung injury is considered to be higher in acute respiratory failure due to interstitial lung disease (ILD), compared to those due to severe infection. However, those sub-phenotypes, which follow irreversible lung injury, remain poorly characterized. We aimed to examine their clinical and radiological features, in patients who could not withdraw from ventilation after receiving any treatment (defined as“irreversible respiratory failure”). Methods: Retrospective study including all patients receiving CT evaluation at onset and invasive mechanical ventilation for severe infection or acute ILD, who admitted our institution from April 2013 to May 2019. Participants were divided into Infection group and ILD group according to the dominant cause, and predictors of irreversible respiratory failure were examined among those subjects. In addition, we quantitatively evaluated the changes in lung region volumes and dispersion of grand glass opacity, using automated methods. Results: 31 patients were subdivided to ILD group, whereas 139 patients were subdivided to Infection group. Significantly more subjects in ILD group developed irreversible respiratory failure (n=22; 70.9%), compared to those in Infection group (n=27; 19.4%; p<0.001). With validation of radiological features in those subjects, distinct CT findings, including lung contractive change and non-edematous lung injury (NE-LI), were found in both groups. Lung contractive change was observed with 23 subjects in ILD group (74.2%) and 7 subjects in Infection group (5.0%). Among those, >10% lung volume reduction was confirmed by CT analysis with 19 subjects in ILD group and 4 subjects in Infection group. By multivariate logistic regression analysis, the following factors were found to be strong predictors of irreversible respiratory failure; lung contractive change (odds ratio [OR]=32.6; 95% confidence interval [CI], 7.1-150), NE-LI suspicious lesion (OR=13.3; 95% CI [2.9-59]), ILD-dominant respiratory failure (OR=18.4; 95% CI, 4.3-79), multidrug-resistant bacterial- or fungal-infection (OR=6.4; 95% CI, 1.3-31). Conclusions: We demonstrated the presence of sub-phenotypes in acute respiratory failure due to ILD and severe infection, which followed an irreversible course with distinctive radiological features including lung contractive changes.

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Urgent Lung Transplantation in Severe Acute Respiratory Failure Based on Rapidly Progressive Interstitial Lung Disease: A Case Report

Transplantation Proceedings ◽

10.1016/j.transproceed.2017.06.020 ◽

2017 ◽

Vol 49 (7) ◽

pp. 1544-1548 ◽

Cited By ~ 3

Author(s):

I. Madurka ◽

J. Elek ◽

N. Schönauer ◽

T. Bartók ◽

K. Kormosói-Tóth ◽

...

Keyword(s):

Case Report ◽

Respiratory Failure ◽

Interstitial Lung Disease ◽

Acute Respiratory Failure ◽

Lung Transplantation ◽

Lung Disease

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Walking assessments as the predictor of acute respiratory failure in the interstitial lung disease patients

10.1183/13993003.congress-2020.705 ◽

2020 ◽

Author(s):

Ryosuke Hirabayashi ◽

Yusuke Takahashi ◽

Kazuma Nagata ◽

Kyosuke Wakata ◽

Yusuke Shima ◽

...

Keyword(s):

Respiratory Failure ◽

Interstitial Lung Disease ◽

Acute Respiratory Failure ◽

Lung Disease

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ERS International Congress 2020 virtual: highlights from the Respiratory Intensive Care Assembly

ERJ Open Research ◽

10.1183/23120541.00214-2021 ◽

2021 ◽

pp. 00214-2021

Author(s):

Camille Rolland-Debord ◽

Alexander D'Haenens ◽

Leire Mendiluce ◽

Lydia Spurr ◽

Shruthi Konda ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Interstitial Lung Disease ◽

Acute Respiratory Failure ◽

Lung Disease ◽

Early Career ◽

International Congress ◽

European Respiratory Society ◽

Diagnostic Strategies

During the virtual European Respiratory Society (ERS) Congress 2020, early career members summarized the sessions organized by the Respiratory Intensive Care Assembly. The topics covered included diagnostic strategies in patients admitted to the Intensive Care unit (ICU) with acute respiratory failure, with a focus on patients with interstitial lung disease and for obvious reasons, SARS-CoV2 infection. These sessions are summarized in this paper, with take-home messages highlighted.

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Trends and seasonal variation of hospitalization and mortality of interstitial lung disease in the United States from 2006 to 2016.

10.21203/rs.3.rs-18341/v2 ◽

2020 ◽

Author(s):

An Ho ◽

Artem Shmelev ◽

Edward Charbek

Keyword(s):

Seasonal Variation ◽

Respiratory Failure ◽

Interstitial Lung Disease ◽

Acute Respiratory Failure ◽

Hospital Admission ◽

Lung Disease ◽

Seasonal Variations ◽

Mortality Rates ◽

Admission Rates ◽

Hospitalization Rates

Abstract Background: In the recent years, the overall trends in hospital admission and mortality of interstitial lung disease (ILD) are unknown. In addition, there was some evidence that interstitial lung disease death rate highest in the winter but this finding was only available in one study. This study will investigate the trend and seasonal variations in hospital admission and mortality rates of ILD from 2006 to 2016.Method: From the Nationwide Inpatient Sample database, we collected all cases with the International Classification of Diseases (ICD)-9 or ICD-10 codes of ILD excluding identifiable external causes (drug, organic or inorganic dusts) from 2006 to 2016. Hospitalization rates of each year were calculated based on U.S Census population data. Monthly hospitalization and in-hospital mortality rates were analyzed by seasonal and trend decomposition. Subgroups of idiopathic interstitial fibrosis (IPF), acute respiratory failure (ARF), pneumonia were analyzed. Results: From 2006 to 2016, all-cause hospital admission rate of patients with interstitial lung disease (ILD) and IPF-only subgroup declined but their overall mortality remained unchanged (except IPF subgroup and acute respiratory failure subgroup). Acute respiratory failure related admission account for 23% of all causes and pneumonia 17.6%. Mortality of ILD in general and subgroup of ILD with ARF was highest in winter, up to 8.13% ± 0.60% and 26.3% ± 10.2% respectively. The seasonal variations of hospital admission and mortality of ILD in general was not changed when infectious pneumonia cases were ruled out. All cause admission rates were highest in months from January to April. Subgroup analysis also showed seasonal variations with highest hospitalization rates for all subgroups (IPF, ARF, pneumonia) in the months from December to April (winter to early Spring).Conclusion: From 2006 to 2016, admission rates of ILD of all causes and IPF subgroup declined but in-hospital mortality remained unchanged. Mortality of IPF subgroup and acute respiratory failure subgroup trended down. All-cause hospital admissions and mortality of ILD have a strong seasonal variation. Hospitalization rates for all subgroups (IPF, ARF, pneumonia) were highest in the months from December to April.

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Interstitial Lung Disease Associated Acute Respiratory Failure Requiring Invasive Mechanical Ventilation: A Retrospective Analysis

10.21203/rs.2.23766/v1 ◽

2020 ◽

Author(s):

Cyrus Vahdatpour ◽

Alexander Pichler ◽

Harold I Palevsky ◽

Michael J Kallan ◽

Namrata B Patel ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Interstitial Lung Disease ◽

Acute Respiratory Failure ◽

Lung Disease ◽

Invasive Mechanical Ventilation ◽

Ventilatory Support ◽

Positive Pressure ◽

High Dose ◽

One Year

Abstract Background Interstitial lung disease (ILD) patients requiring invasive mechanical ventilation (IMV) for acute respiratory failure (ARF) are known to have a poor prognosis. Few studies have investigated determinants of outcomes and the utility of trialing non-invasive positive pressure ventilation (NIPPV) prior to IMV to see if there are any effect(s) on mortality or morbidity. Methods We designed a retrospective study using patients at four different intensive care units within one health care system. Our primary objective was to determine if there are differences in outcomes for in-hospital and one-year mortality between patients who undergo NIPPV prior to IMV and those who receive only IMV. A secondary objective was to identify potential determinants of outcomes. Results Of 54 ILD patients with ARF treated with IMV, 20 (37.0%) survived to hospital discharge and 10 (18.5%) were alive at one-year. There was no significant mortality difference between patients trialed on NIPPV prior to IMV and those receiving only IMV. Several key determinants of outcomes were identified with higher mortality, including: higher ventilatory support, idiopathic pulmonary fibrosis (IPF) subtype, high dose steroids, use of vasopressors, supraventricular tachycardias (SVTs), and higher body mass index. Conclusions Considering that patients trialed on NIPPV prior to IMV was associated with no mortality disadvantage to patients treated with only IMV, trialing patients on NIPPV may identify responders and avoid complications associated with IMV. Increased ventilator support, need of vasopressors, SVTs, and high dose steroids reflect higher mortality and palliative care involvement should be considered as early as possible if lung transplant is not an option.

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