Outcome and prognostic factors of interstitial lung disease patients with acute respiratory failure in the intensive care unit

Background: There are few studies reporting the clinical characteristics and outcomes of interstitial lung disease (ILD) patients with acute respiratory failure (ARF). The goal of this study is to investigate the clinical features, management, mortality, and associated factors in ILD patients with ARF requiring mechanical ventilation (MV). Methods: This was a retrospective, observational study conducted in a 24-bed intensive care unit (ICU) of a medical center in Taiwan during a 3-year period. Patients admitted to the ICU with a diagnosis of ILD with ARF needing MV were included for analysis. Patient characteristics, including demographics, critical-illness factors, and outcome data, were collected and analyzed. Results: A total of 82 patients with ILD who developed ARF were admitted to the ICU during the study period. At the onset of ARF, 38 patients received invasive MV, while 44 patients were treated with noninvasive MV. Overall in-hospital mortality was 65.9%, and 90-day and 1-year mortality were 69.5% and 76.8%, respectively. The independent risk factors for in-hospital mortality were worse oxygenation on days 5 and 7 after the onset of ARF. Invasive MV patients had significantly lower albumin levels, had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores at the onset of ARF, and received more vasopressors, sedatives, and corticosteroid pulse therapy during hospitalization compared with noninvasive MV patients. Conclusion: High in-hospital and long-term mortality rates were observed in ILD patients with ARF requiring MV. Poor oxygenation during hospitalization could serve as a predictive factor of poor prognosis. The reviews of this paper are available via the supplemental material section.

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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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Procalcitonin in patients with influenza A (H1N1) infection and acute respiratory failure

Einstein (São Paulo) ◽

10.1590/s1679-45082011ao1878 ◽

2011 ◽

Vol 9 (1) ◽

pp. 52-55

Author(s):

Péricles Almeida Delfino Duarte ◽

Carla Sakuma de Oliveira Bredt ◽

Gerson Luís Bredt Jr ◽

Amaury César Jorge ◽

Alisson Venazzi ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Influenza A ◽

Laboratory Data ◽

Sepsis Group ◽

Influenza A H1n1 ◽

Low Serum

ABSTRACT Objective: To verify serum procalcitonin levels of patients with acute respiratory failure secondary to influenza A (H1N1) upon their admission to the Intensive Care Unit and to compare these results to values found in patients with sepsis and trauma admitted to the same unit. Methods: Analysis of records of patients infected with influenza A (H1N1) and respiratory failure admitted to the General Intensive Care Unit during in a period of 60 days. The values of serum procalcitonin and clinical and laboratory data were compared to those of all patients admitted with sepsis or trauma in the previous year. Results: Among patients with influenza A (H1N1) (n = 16), the median serum procalcitonin level upon admission was 0.11 ng/mL, lower than in the sepsis group (p < 0.001) and slightly lower than in trauma patients. Although the mean values were low, serum procalcitonin was a strong predictor of hospital mortality in patients with influenza A (H1N1). Conclusion: Patients with influenza A (H1N1) with severe acute respiratory failure presented with low serum procalcitonin values upon admission, although their serum levels are predictors of hospital mortality. The kinetics study of this biomarker may be a useful tool in the management of this group of patients.

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Factors associated with hospital mortality in renal transplant patients admitted to the intensive care unit with acute respiratory failure

Brazilian Journal of Nephrology ◽

10.5935/0101-2800.20170076 ◽

2017 ◽

Vol 39 (4) ◽

Author(s):

Rafael Mendes da Silva ◽

Flavio Geraldo Rezende de Freitas ◽

Antonio Tonete Bafi ◽

Hélio Tedesco Silva Junior ◽

Bartira de Aguiar Roza

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Renal Transplant ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Factors Associated ◽

Transplant Patients ◽

Renal Transplant Patients

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Efficacy of extracorporeal membrane oxygenation for acute respiratory failure with interstitial lung disease: a case control nationwide dataset study in Japan

Respiratory Research ◽

10.1186/s12931-021-01805-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yuko Usagawa ◽

Kosaku Komiya ◽

Mari Yamasue ◽

Kiyohide Fushimi ◽

Kazufumi Hiramatsu ◽

...

Keyword(s):

Prognostic Factors ◽

Respiratory Failure ◽

Interstitial Lung Disease ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Lung Disease ◽

Case Control ◽

Antifungal Drugs ◽

Membrane Oxygenation

Abstract Background Whether acute respiratory failure in patients with interstitial lung disease is reversible remains uncertain. Consequently, indications for extracorporeal membrane oxygenation in these patients are still controversial, except as a bridge to lung transplantation. The objective of this study was to clarify in-hospital mortality and prognostic factors in interstitial lung disease patients undergoing extracorporeal membrane oxygenation. Methods In this case–control study using the Japanese Diagnosis Procedure Combination database, hospitalized interstitial lung disease patients receiving invasive mechanical ventilation and extracorporeal membrane oxygenation from 2010 to 2017 were reviewed. Patients’ characteristics and treatment regimens were compared between survivors and non-survivors to identify prognostic factors. To avoid selection biases, patients treated with extracorporeal membrane oxygenation as a bridge to lung transplantation were excluded. Results A total of 164 interstitial lung disease patients receiving extracorporeal membrane oxygenation were included. Their in-hospital mortality was 74.4% (122/164). Compared with survivors, non-survivors were older and received high-dose cyclophosphamide, protease inhibitors, and antifungal drugs more frequently, but macrolides and anti-influenza drugs less frequently. On multivariate analysis, the following factors were associated with in-hospital mortality: advanced age (odds ratio [OR] 1.043; 95% confidence interval [CI] 1.009–1.078), non-use of macrolides (OR 0.305; 95% CI 0.134–0.698), and use of antifungal drugs (OR 2.416; 95% CI 1.025–5.696). Conclusions Approximately three-quarters of interstitial lung disease patients undergoing extracorporeal membrane oxygenation died in hospital. Moreover, advanced age, non-use of macrolides, and use of antifungal drugs were found to correlate with a poor prognosis.

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Efficacy of extracorporeal membrane oxygenation for acute respiratory failure with interstitial lung disease; a case control nationwide dataset study in Japan

10.21203/rs.3.rs-152666/v2 ◽

2021 ◽

Author(s):

Yuko Usagawa ◽

Kosaku Komiya ◽

Mari Yamasue ◽

Kiyohide Fushimi ◽

Kazufumi Hiramatsu ◽

...

Keyword(s):

Respiratory Failure ◽

Interstitial Lung Disease ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Lung Transplantation ◽

Lung Disease ◽

Case Control ◽

Antifungal Drugs ◽

Membrane Oxygenation

Abstract Background: Since it is uncertain whether acute respiratory failure in patients with interstitial lung disease is reversible, indications for extracorporeal membrane oxygenation in these patients remain controversial, except for bridging to lung transplantation. The objective of this study was to clarify in-hospital mortality and prognostic factors in interstitial lung disease patients undergoing extracorporeal membrane oxygenation.Methods: Case-control study. Using the Japanese Diagnosis Procedure Combination database from 2010 to 2017, we reviewed hospitalized interstitial lung disease patients receiving invasive mechanical ventilation and extracorporeal membrane oxygenation. As we focused on the efficacy of extracorporeal membrane oxygenation as an intervention for managing merely acute respiratory failure, patients treated with extracorporeal membrane oxygenation as a bridge to lung transplantation were excluded.Results: A total of 164 interstitial lung disease patients receiving extracorporeal membrane oxygenation were included. In-hospital mortality of them was 74.4% (122/164). Compared with survivors, non-survivors were older and received high-dose cyclophosphamide, protease inhibitors, and antifungal drugs more frequently but macrolides and anti-influenza drugs less frequently. Multivariate analysis revealed the following factors were associated with in-hospital mortality: advanced age with an odds ratio (OR) of 1.048 and a 95% confidence interval (CI) of 1.015–1.082, non-use of macrolides (OR, 0.264; 95% CI, 0.118–0.589), and use of antifungal drugs (OR, 3.158; 95% CI, 1.377–7.242).Conclusions: Approximately three quarters of interstitial lung disease patients undergoing extracorporeal membrane oxygenation died in hospital. Moreover, advanced age, non-use of macrolides, and use of antifungal drugs were found to correlate with a poor prognosis.

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Cyclophosphamide for interstitial lung disease-associated acute respiratory failure: mortality, clinical response and radiological characteristics

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01615-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Johanna P. van Gemert ◽

Inge A. H. van den Berk ◽

Esther J. Nossent ◽

Leo M. A. Heunks ◽

Rene E. Jonkers ◽

...

Keyword(s):

Respiratory Failure ◽

Interstitial Lung Disease ◽

Mortality Rate ◽

Connective Tissue ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Lung Disease ◽

Clinical Response ◽

Mortality Rates ◽

Cyclophosphamide Treatment

Abstract Background Treatment for interstitial lung disease (ILD) patients with acute respiratory failure (ARF) is challenging, and literature to guide such treatment is scarce. The reported in-hospital mortality rates of ILD patients with ARF are high (62–66%). Cyclophosphamide is considered a second-line treatment in steroid-refractory ILD-associated ARF. The first aim of this study was to evaluate the in-hospital mortality in patients with ILD-associated ARF treated with cyclophosphamide. The second aim was to compare computed tomographic (CT) patterns and physiological and ventilator parameters between survivors and non-survivors. Methods Retrospective analysis of patients with ILD-associated ARF treated with cyclophosphamide between February 2016 and October 2017. Patients were categorized into three subgroups: connective tissue disease (CTD)-associated ILD, other ILD or vasculitis. In-hospital mortality was evaluated in the whole cohort and in these subgroups. Clinical response was determined using physiological and ventilator parameters: Sequential Organ Failure Assessment Score (SOFA), PaO2/FiO2 (P/F) ratio and dynamic compliance (Cdyn) before and after cyclophosphamide treatment. The following CT features were quantified: ground-glass opacification (GGO) proportion, reticulation proportion, overall extent of parenchymal disease and fibrosis coarseness score. Results Fifteen patients were included. The overall in-hospital mortality rate was 40%. In-hospital mortality rates for CTD-associated ILD, other ILD and vasculitis were 20, 57, and 33%, respectively. The GGO proportion (71% vs 45%) was higher in non-survivors. There were no significant differences in the SOFA score, P/F ratio or Cdyn between survivors and non-survivors. However, in survivors the P/F ratio increased from 129 to 220 mmHg and Cdyn from 75 to 92 mL/cmH2O 3 days after cyclophosphamide treatment. In non-survivors the P/F ratio hardly changed (113–114 mmHg) and Cdyn even decreased (27–20 mL/cmH2O). Conclusion In this study, we found a mortality rate of 40% in patients treated with cyclophosphamide for ILD-associated ARF. Connective tissue disease-associated ILD and vasculitis were associated with a lower risk of death. In non-survivors, the CT GGO proportion was significantly higher. The P/F ratio and Cdyn in survivors increased after 3 days of cyclophosphamide treatment.

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Efficacy of Extracorporeal Membrane Oxygenation for Acute Respiratory Failure with Interstitial Lung Disease; A Case Control Nationwide Dataset Study in Japan

10.21203/rs.3.rs-152666/v1 ◽

2021 ◽

Author(s):

Yuko Usagawa ◽

Kosaku Komiya ◽

Mari Yamasue ◽

Kiyohide Fushimi ◽

Kazufumi Hiramatsu ◽

...

Keyword(s):

Respiratory Failure ◽

Interstitial Lung Disease ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Lung Transplantation ◽

Lung Disease ◽

Case Control ◽

Antifungal Drugs ◽

Membrane Oxygenation

Abstract Background: Since it is uncertain whether acute respiratory failure in patients with interstitial lung disease is reversible, indications for extracorporeal membrane oxygenation in these patients remain controversial, except for bridging to lung transplantation. The objective of this study was to clarify in-hospital mortality and prognostic factors in interstitial lung disease patients undergoing extracorporeal membrane oxygenation.Study design and Methods: Case-control study. Using the Japanese Diagnosis Procedure Combination database, we reviewed hospitalized interstitial lung disease patients receiving invasive mechanical ventilation and extracorporeal membrane oxygenation for acute respiratory failure from 2010 to 2017. As we focused on the efficacy of extracorporeal membrane oxygenation as an intervention for managing merely acute respiratory failure, patients treated with extracorporeal membrane oxygenation as a bridge to lung transplantation were excluded.Results: A total of 164 interstitial lung disease patients receiving extracorporeal membrane oxygenation were included, 122 of whom (74.4%) died during hospitalization. Compared with survivors, non-survivors were older and received high-dose cyclophosphamide, protease inhibitors, and antifungal drugs more frequently but macrolides and anti-influenza drugs less frequently. Multivariate analysis revealed the following factors were associated with in-hospital mortality: advanced age with an odds ratio (OR) of 1.048 and a 95% confidence interval (CI) of 1.015–1.082, non-use of macrolides (OR, 0.264; 95% CI, 0.118–0.589), and use of antifungal drugs (OR, 3.158; 95% CI, 1.377–7.242).Conclusions: Approximately three quarters of interstitial lung disease patients undergoing extracorporeal membrane oxygenation died in hospital. Moreover, advanced age, non-use of macrolides, and use of antifungal drugs were found to correlate with a poor prognosis.

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Noninvasive respiratory support outside the intensive care unit for acute respiratory failure related to coronavirus-19 disease: a systematic review and meta-analysis

Critical Care ◽

10.1186/s13054-021-03697-0 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Gianmaria Cammarota ◽

Teresa Esposito ◽

Danila Azzolina ◽

Roberto Cosentini ◽

Francesco Menzella ◽

...

Keyword(s):

Intensive Care Unit ◽

Clinical Trials ◽

Intensive Care ◽

Respiratory Failure ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Meta Analysis ◽

Invasive Mechanical Ventilation ◽

Ventilatory Support ◽

Respiratory Support

Abstract Background Noninvasive respiratory support (NIRS) has been diffusely employed outside the intensive care unit (ICU) to face the high request of ventilatory support due to the massive influx of patients with acute respiratory failure (ARF) caused by coronavirus-19 disease (COVID-19). We sought to summarize the evidence on clinically relevant outcomes in COVID-19 patients supported by NIV outside the ICU. Methods We searched PUBMED®, EMBASE®, and the Cochrane Controlled Clinical trials register, along with medRxiv and bioRxiv repositories for pre-prints, for observational studies and randomized controlled trials, from inception to the end of February 2021. Two authors independently selected the investigations according to the following criteria: (1) observational study or randomized clinical trials enrolling ≥ 50 hospitalized patients undergoing NIRS outside the ICU, (2) laboratory-confirmed COVID-19, and (3) at least the intra-hospital mortality reported. Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines were followed. Data extraction was independently performed by two authors to assess: investigation features, demographics and clinical characteristics, treatments employed, NIRS regulations, and clinical outcomes. Methodological index for nonrandomized studies tool was applied to determine the quality of the enrolled studies. The primary outcome was to assess the overall intra-hospital mortality of patients under NIRS outside the ICU. The secondary outcomes included the proportions intra-hospital mortalities of patients who underwent invasive mechanical ventilation following NIRS failure and of those with ‘do-not-intubate’ (DNI) orders. Results Seventeen investigations (14 peer-reviewed and 3 pre-prints) were included with a low risk of bias and a high heterogeneity, for a total of 3377 patients. The overall intra-hospital mortality of patients receiving NIRS outside the ICU was 36% [30–41%]. 26% [21–30%] of the patients failed NIRS and required intubation, with an intra-hospital mortality rising to 45% [36–54%]. 23% [15–32%] of the patients received DNI orders with an intra-hospital mortality of 72% [65–78%]. Oxygenation on admission was the main source of between-study heterogeneity. Conclusions During COVID-19 outbreak, delivering NIRS outside the ICU revealed as a feasible strategy to cope with the massive demand of ventilatory assistance. Registration PROSPERO, https://www.crd.york.ac.uk/prospero/, CRD42020224788, December 11, 2020.

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