Predictors of Mortality in Patients Undergoing Autologous Stem Cell Transplant (ASCT) Admitted to the Intensive Care Unit: An Institutional Review of 1013 Transplant Patients over Five Years.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2876-2876
Author(s):  
Martina A. Trinkaus ◽  
Stephen E. Lapinsky ◽  
David C. Hallett ◽  
Norman Franke ◽  
Andrew Winter ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Multiple Myeloma ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Febrile Neutropenia ◽  
Organ Failure ◽  
Admission Rate ◽  
Apache Ii ◽  
Gram Negative ◽  
Icu Admission

Abstract Study Objective: To describe the outcomes of ASCT recipients transferred to the Intensive Care Unit (ICU), and identify predictors for mortality. Methods: Retrospective review of all ASCT recipients from Jan 2001-July 2006 who required ICU transfer up to 100 days post ASCT. Measurements and main Results: Thirty-four of 1013 patients (3.3%) who underwent ASCT, were admitted to the ICU. The mean age at admission was 54.9 +/− 11.1 (range 28–71), 53% being female. Indications for ASCT included multiple myeloma (50%), amyloidosis (32%), or other malignancies (18%). Table 1 highlights the admission rate to the ICU by diagnosis. The primary admitting diagnosis in the ICU included sepsis (32%), cardiac related events (26%), or respiratory compromise (29%). Median days post ASCT was 10.0 days with a median in ICU stay of 4.0 days (range 1–37 days). Twenty patients (including all non-survivors) required mechanical ventilation for > 24 hours with a median duration of 3.0 days. Thirteen patients died (38%) in the ICU, with 11 dying of multi-system organ failure and 2 from cardiac arrest. Retrospectively collected parameters restricted to the first 24 hours of admission revealed that Sequential Organ Failure Assessment (SOFA) score (OR 1.30; CI95 1.09–1.64, P=0.003) and Acute Physiology and Chronic Health Evaluation (APACHE II) score (OR 1.43; CI95 1.14–2.16; P=0.0002) were statistically associated with mortality in univariate analysis. The variables predictive of mortality at 24 hours after admission are displayed in Table 2. Conclusion: ICU admission is uncommon, occuring in 3% of patients undergoing ASCT, of which 38% die (1% of total ASCTs). Admission is influenced by underlying diagnosis, with amyloid patients portending the highest risk. Mortality in ASCT patients admitted to the ICU can be predicted in the first 24 hours by specific assessment scores (SOFA and APACHE II); specific supportive care requirements: inotropic dependence, hemodialysis, and need for ventilation; and clinical findings of gram negative sepsis or > 2 organ failure. Patients with febrile neutropenia had a low risk of mortality (possibly due to aggressive antibiotic use, growth factors, and rapid engraftment post ASCT). These results may assist clinical decision making regarding the continuation of intensive care delivered 24 hours after admission. Percentage Admission Rate by Diagnosis (n = 1013) Diagnosis ASCT (#) ICU Admission (#)/ (%) Non-survivors (#) Multiple Myeloma 615 17 / (2.8%) 6 Non-Hodgkin’s Lymphoma 199 2/ (1.0%) 1 Hodgkin’s Lymphoma 112 1 / (0.9%) 0 Amyloidosis 39 11/ (28.2%) 6 Acute Myeloid Leukemia 17 1/ (5.9%) 0 Other (Germ Cell Tumour, Waldenstrom’s Macroglobuliemia, POEMS) 31 2/ (6.4%) 0 Variables Predictive of Mortality at 24 hours after Admission Variable Predictors Number of Patients Survivors (n = 21) Non-survivors (n = 13) P-value Febrile Neutropenia 15 13 (62%) 2 (15%) 0.013 Failure of > 2 organs 20 9 (43%) 11 (85%) 0.030 Mechanical Ventilation 20 9 (43%) 11 (85%) 0.030 Inotropic Support > 4 hours 10 3 (14%) 7 (54%) 0.022 Hemodialysis 12 4 (19%) 8 (62%) 0.025 Gram Negative Infection 6 1 (5%) 5 (42%) 0.016

scholarly journals Outcome and Prognostic Factors of Patients with Hematological Malignancies Admitted to an Intensive Care Unit

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4796-4796
Author(s):  
Pak Ling Lui ◽  
Rakshya Pandey ◽  
Jonathan Tian En Koh ◽  
Eng Soo Yap ◽  
Amartya Mukhopadhyay ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Hematological Malignancies ◽  
Apache Ii ◽  
Refractory Disease ◽  
Laboratory Measurements ◽  
Icu Mortality ◽  
Icu Admission ◽  
Icu Outcome

Abstract Background Patients with hematological malignancies (HM) often develop complications due to their treatment or their underlying disease, requiring admission to an intensive care unit (ICU). Historically, it has been believed that the outcome of these patients were poor. However, there is emerging evidence showing improvements in ICU outcome for patients with HM, as well as for other patients with critical illness. This study aimed to study the outcomes and prognostic factors for patients with HM admitted to the ICU of a tertiary hospital in Asia. Methods We reviewed the case records of consecutive ICU admissions for patients under the hematology service in our institution, from July 2010 to June 2014. Patients who did not have a HM and those who were admitted for monitoring following an elective procedure were excluded. Clinical information was gathered, including details of their HM, co-morbidities, clinical status on admission to ICU, laboratory measurements, and treatment received in ICU. Sepsis-related Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were calculated. These were all evaluated for association with the primary outcome of survival to ICU discharge. Results A total of 288 admission episodes were reviewed, of which 264 were included for analysis. Of the excluded patients, 23 did not have a HM, and 1 was admitted following elective surgery. Overall ICU mortality was 34.8%, and overall hospital mortality was 45.8%. The mean duration of ICU stay was 5.3 days. The type of HM did not significantly affect the outcome (P = 0.87), nor did the presence of relapsed/refractory disease (P = 0.38). Neutropenia (< 1 x 109 /L) was associated with higher mortality (P = 0.02), as was the presence of a positive blood culture (P = 0.002). (Table 1) The use of red blood cell (P = 0.58) and platelet transfusions (P = 0.10) did not significantly affect the outcome. Patients who required the use of mechanical ventilation (P < 0.001) and vasopressor drugs (P < 0.001) did worse, but those who required the use of renal replacement therapy (P = 0.57) did not. Higher SOFA and APACHE II scores were both associated with higher rates of ICU mortality (both P < 0.001). Among the laboratory measurements on admission, platelet count, bilirubin, and aspartate aminotransferase (AST) were significantly different between survivors and non-survivors, while there were no significant differences in hemoglobin, white blood cell (WBC) count, sodium, potassium, urea, creatinine, and alanine aminotransferase (ALT) between the two groups. The 9 variables that were found to be significant with P < 0.05 were analyzed in a multivariable logistic regression model. APACHE II score (P < 0.001), use of mechanical ventilation (P = 0.003), use of vasopressor drugs (P < 0.001), and serum bilirubin (P = 0.004) were found to be independently associated with ICU mortality. Conclusion Patients with HM requiring ICU admission in our study had comparable survival to previous published studies. Physiological parameters and indicators of organ dysfunction at the point of ICU admission were predictors of ICU mortality. The type of HM and the presence of refractory disease did not have a significant effect on ICU outcome. This information can also help to determine which patients would benefit most from intensive care, which remains a costly and limited resource. The results also suggest that patients should not be denied ICU admission solely based on the status of their HM. Disclosures No relevant conflicts of interest to declare.

scholarly journals Changes in muscle ultrasound for the diagnosis of intensive care unit acquired weakness in critically ill patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Weiqing Zhang ◽  
Jun Wu ◽  
Qiuying Gu ◽  
Yanting Gu ◽  
Yujin Zhao ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Diagnostic Accuracy ◽  
Biceps Brachii ◽  
Rectus Femoris ◽  
Apache Ii ◽  
Cross Sectional ◽  
Icu Admission ◽  
The Right ◽  
Muscle Ultrasound

AbstractTo test diagnostic accuracy of changes in thickness (TH) and cross-sectional area (CSA) of muscle ultrasound for diagnosis of intensive care unit acquired weakness (ICU-AW). Fully conscious patients were subjected to muscle ultrasonography including measuring the changes in TH and CSA of biceps brachii (BB) muscle, vastus intermedius (VI) muscle, and rectus femoris (RF) muscles over time. 37 patients underwent muscle ultrasonography on admission day, day 4, day 7, and day 10 after ICU admission, Among them, 24 were found to have ICW-AW. Changes in muscle TH and CSA of RF muscle on the right side showed remarkably higher ROC-AUC and the range was from 0.734 to 0.888. Changes in the TH of VI muscle had fair ROC-AUC values which were 0.785 on the left side and 0.779 on the right side on the 10th day after ICU admission. Additionally, Sequential Organ Failure Assessment (SOFA), Acute Physiology, and Chronic Health Evaluation II (APACHE II) scores also showed good discriminative power on the day of admission (ROC-AUC 0.886 and 0.767, respectively). Ultrasonography of changes in muscles, especially in the TH of VI muscle on both sides and CSA of RF muscle on the right side, presented good diagnostic accuracy. However, SOFA and APACHE II scores are better options for early ICU-AW prediction due to their simplicity and time efficiency.

Single Centre Experience of Patients with Haematological Malignancies Admitted to Intensive Care Unit: A Comparative Review of Allogenic Bone Marrow Transplant Data.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1830-1830
Author(s):  
Zi Yi Lim ◽  
Jane Graham ◽  
Sylvia Simpson ◽  
Stephen Devereux ◽  
Antonio Pagliuca ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Overall Survival ◽  
Intensive Care ◽  
Inotropic Support ◽  
Haematological Malignancies ◽  
Term Survival ◽  
Icu Admission ◽  
Icu Outcome ◽  
Reduced Intensity

Abstract Introduction: Previous studies have indicated that the prognosis of patients with haematological malignancies who are admitted to intensive care unit (ICU) is poor. In particular, it has been suggested that the mortality for allogenic BMT patients requiring ICU admission is particularly high. The recent increased usage of reduced intensity conditioning has allowed allogenic transplantation of older patients who would previously be unsuitable for BMT. It is however unclear as to whether these patients may have a better ICU outcome. Methods: A retrospective review was performed of all haemato-oncology admissions to Kings College Hospital from May 2000 to Apr 2004 who were subsequently admitted to ICU. Information was collected from all patients for demographic factors, haematological status, APACHE score, organ dysfunction, microbiological data, and supportive organ therapy at point of admission to and during ICU stay. All variables were evaluated for prognostic relevance by univariate and multivariate analyses. Post-ICU survival was examined at day 30 and 1 year. Results: There were a total of 1249 admissions during the study period, of which 330(26.4%) were BMT patients. 57 ICU admissions (55 patients) were documented, 31 non-BMT (3.3%) vs 26 BMT (8.5%). The diagnoses were AML/MDS 26 (47.3%), ALL 6 (10.9%), NHL/HD 14 (25.5%), myeloma 5 (9.1%), others 4 (7.2%). Amongst post BMT patients, type of conditioning received was: reduced intensity 50%(13), standard myeloablative 34.6%(9), autologous 15.3%(4). 14 patients were early admissions within 6 months of BMT. The main cause of admission to ICU was due to chest sepsis with acute hypoxaemia. Conventional mechanical ventilation (MV) was used in 43(72.9%) of patients, and non-invasive MV in 16(27.1%). 30(50.8%) of patients received inotropic support during their ICU admission. Main cause of death was due to acute respiratory distress syndrome. There was no significant difference in age, duration of ICU admission and mechanical ventilation between non-BMT and BMT patients. However, the BMT group had higher numbers of myeloid malignancies, neutropenia, and intropic support. Overall ICU survival for the entire group, non-BMT, allogenic BMT (myeloablative + RIC) patients was 29.8%, 32.3% and 27.3% respectively. Kaplan-Meier estimation of longer term survival for these three groups at 30 day and 12 months was 23.7% and 14.6%, 20.1% and 10.9%, 24.3% and 19.5% respectively. The overall survival between these patient groups was not significant (p-value 0.757). Sub-analysis of RIC BMT data for 30 day and 1 year outcome was 35.8% and 29.3%, none of the 9 myeloablative patients survived beyond day 30. Univariate analysis identified intropic support, renal failure (creatinine >150), thrombocytopenia (platelet < 50) as significant variables for increased mortality (p-values 0.005, 0.012, 0.007 respectively). Results of multivariate analysis showed that inotropic support, was the only independant factor associated with increased ICU mortality. Estimated 30 day and 1 year survival for patients receiving vs not receiving inotropic support was 8% vs 39% and 6% vs 24%. Conclusion: Our data demonstrates that the admission of haemato-oncology patients to ICU can be associated with a favourable outcome. Significantly, in our cohort the overall survival of allogenic BMT patients was comparable with non-BMT patients. In addition, RIC patients appear to have a good ICU outcome and longer term survival.

scholarly journals A Modified Sequential Organ Failure Assessment Score for Critical Care Triage

2010 ◽  
Vol 4 (4) ◽  
pp. 277-284 ◽  
Author(s):  
Colin K. Grissom ◽  
Samuel M. Brown ◽  
Kathryn G. Kuttler ◽  
Jonathan P. Boltax ◽  
Jason Jones ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Confidence Interval ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Laboratory Measurement ◽  
Receiver Operating Curve ◽  
Failure Assessment

ABSTRACTObjective: The Sequential Organ Failure Assessment (SOFA) score has been recommended for triage during a mass influx of critically ill patients, but it requires laboratory measurement of 4 parameters, which may be impractical with constrained resources. We hypothesized that a modified SOFA (MSOFA) score that requires only 1 laboratory measurement would predict patient outcome as effectively as the SOFA score.Methods: After a retrospective derivation in a prospective observational study in a 24-bed medical, surgical, and trauma intensive care unit, we determined serial SOFA and MSOFA scores on all patients admitted during the 2008 calendar year and compared the ability to predict mortality and the need for mechanical ventilation.Results: A total of 1770 patients (56% male patients) with a 30-day mortality of 10.5% were included in the study. Day 1 SOFA and MSOFA scores performed equally well at predicting mortality with an area under the receiver operating curve (AUC) of 0.83 (95% confidence interval 0.81-.85) and 0.84 (95% confidence interval 0.82-.85), respectively (P = .33 for comparison). Day 3 SOFA and MSOFA predicted mortality for the 828 patients remaining in the intensive care unit with an AUC of 0.78 and 0.79, respectively. Day 5 scores performed less well at predicting mortality. Day 1 SOFA and MSOFA predicted the need for mechanical ventilation on day 3, with an AUC of 0.83 and 0.82, respectively. Mortality for the highest category of SOFA and MSOFA score (>11 points) was 53% and 58%, respectively.Conclusions: The MSOFA predicts mortality as well as the SOFA and is easier to implement in resource-constrained settings, but using either score as a triage tool would exclude many patients who would otherwise survive.(Disaster Med Public Health Preparedness. 2010;4:277-284)

Risk Factors Associated With Resistance to Ciprofloxacin in Clinical Bacterial Isolates From Intensive Care Unit Patients

2007 ◽  
Vol 28 (3) ◽  
pp. 331-336 ◽  
Author(s):  
Phillip D. Levin ◽  
Robert A. Fowler ◽  
Cameron Guest ◽  
William J. Sibbald ◽  
Alex Kiss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Prior Treatment ◽  
Bacterial Isolates ◽  
Icu Patients ◽  
Gram Negative ◽  
Factors Associated ◽  
Icu Admission ◽  
Ciprofloxacin Resistance

Objective.To determine risk factors and outcomes associated with ciprofloxacin resistance in clinical bacterial isolates from intensive care unit (ICU) patients.Design.Prospective cohort study.Setting.Twenty-bed medical-surgical ICU in a Canadian tertiary care teaching hospital.Patients.All patients admitted to the ICU with a stay of at least 72 hours between January 1 and December 31, 2003.Methods.Prospective surveillance to determine patient comorbidities, use of medical devices, nosocomial infections, use of antimicrobials, and outcomes. Characteristics of patients with a ciprofloxacin-resistant gram-negative bacterial organism were compared with characteristics of patients without these pathogens.Results.Ciprofloxacin-resistant organisms were recovered from 20 (6%) of 338 ICU patients, representing 38 (21%) of 178 nonduplicate isolates of gram-negative bacilli. Forty-nine percent ofPseudomonas aeruginosaisolates and 29% ofEscherichia coliisolates were resistant to ciprofloxacin. In a multivariate analysis, independent risk factors associated with the recovery of a ciprofloxacin-resistant organism included duration of prior treatment with ciprofloxacin (relative risk [RR], 1.15 per day [95% confidence interval {CI}, 1.08-1.23];P< .001), duration of prior treatment with levofloxacin (RR, 1.39 per day [95% CI, 1.01-1.91];P= .04), and length of hospital stay prior to ICU admission (RR, 1.02 per day [95% CI, 1.01-1.03];P= .005). Neither ICU mortality (15% of patients with a ciprofloxacin-resistant isolate vs 23% of patients with a ciprofloxacin-susceptible isolate;P= .58 ) nor in-hospital mortality (30% vs 34%;P= .81 ) were statistically significantly associated with ciprofloxacin resistance.Conclusions.ICU patients are at risk of developing infections due to ciprofloxacin-resistant organisms. Variables associated with ciprofloxacin resistance include prior use of fluoroquinolones and duration of hospitalization prior to ICU admission. Recognition of these risk factors may influence antibiotic treatment decisions.

Super Obesity in the Medical Intensive Care Unit

2018 ◽  
Vol 35 (5) ◽  
pp. 478-484
Author(s):  
Santhi Iyer Kumar ◽  
Kathleen Doo ◽  
Julie Sottilo-Brammeier ◽  
Christianne Lane ◽  
Janice M. Liebler
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Apache Ii ◽  
Obese Patients ◽  
Super Obesity ◽  
Super Obese ◽  
Medical Intensive Care ◽  
Reason For Admission

Background: Studies exploring the effect of body mass index (BMI) on outcomes in the intensive care unit (ICU) have yielded mixed results, with few studies assessing patients at the extremes of obesity. We sought to understand the clinical characteristics and outcomes of patients with super obesity (BMI > 50 kg/m2) as compared to morbid obesity (BMI > 40 kg/m2) and obesity (BMI > 30 kg/m2). Methods: A retrospective review of patients admitted to the Los Angeles County + University of Southern California medical intensive care unit (MICU) service between 2008 and 2013 was performed. The first 150 patients with BMI 30 to 40, 40 to 50, and 50+ were separated into groups. Demographic data, comorbid conditions, reason for admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, serum bicarbonate, and arterial carbon dioxide pressure (Pco 2) at admission were collected. Hospital and ICU length of stay (LOS), discharge disposition, mortality, use of mechanical ventilation (invasive and noninvasive), use of radiography, and other clinical outcomes were also recorded. Results: There was no difference in age, sex, and APACHE II score among the 3 groups. A pulmonary etiology was the most common reason for admission in the higher BMI categories ( P < .001). There was no difference in mortality among the groups. Intensive care unit and hospital LOS rose with increasing BMI ( P < .001). Patients admitted for pulmonary etiologies and higher BMIs had an increased ICU and hospital LOS ( P < .001). Super obese patients used significantly more noninvasive mechanical ventilation (NIMV, P < .001). There were no differences in the use of invasive mechanical ventilation across the groups. Conclusion: Super obese patients are most commonly admitted to the MICU with pulmonary diagnoses and have an increased use of noninvasive ventilation. Super obesity was not associated with increased ICU mortality. Clinicians should be prepared to offer NIMV to super obese patients and anticipate a longer LOS in this group.

Duration of Mechanical Ventilation in an Adult Intensive Care Unit After Introduction of Sedation and Pain Scales

2008 ◽  
Vol 17 (4) ◽  
pp. 349-356 ◽  
Author(s):  
Teresa Ann Williams ◽  
Suzanne Martin ◽  
Gavin Leslie ◽  
Linda Thomas ◽  
Timothy Leen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pain Scale ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Adult Intensive Care Unit ◽  
Before And After ◽  
Behavioral Pain Scale ◽  
Sedation And Analgesia

Background Sedation and analgesia scales promote a less-distressing experience in the intensive care unit and minimize complications for patients receiving mechanical ventilation. Objectives To evaluate outcomes before and after introduction of scales for sedation and analgesia in a general intensive care unit. Method A before-and-after design was used to evaluate introduction of the Richmond Agitation-Sedation Scale and the Behavioral Pain Scale for patients receiving mechanical ventilation. Data were collected for 6 months before and 6 months after training in and introduction of the scales. Results A total of 769 patients received mechanical ventilation for at least 6 hours (369 patients before and 400 patients after implementation). Age, scores on the Acute Physiology and Chronic Health Evaluation (APACHE) II, and diagnostic groups were similar in the 2 groups, but the after group had more men than did the before group. Duration of mechanical ventilation did not change significantly after the scales were introduced (median, 24 vs 28 hours). For patients who received mechanical ventilation for 96 hours or longer (24%), mechanical ventilation lasted longer after implementation of the scales (P =.03). Length of stay in the intensive care unit was similar in the 2 groups (P = .18), but patients received sedatives for longer after implementation (P=.01). By logistic regression analysis, APACHE II score (P &lt;.001) and diagnostic group (P &lt;.001) were independent predictors of mechanical ventilation lasting 96 hours or longer. Conclusion Sedation and analgesia scales did not reduce duration of ventilation in an Australian intensive care unit.

scholarly journals Outcome of Patients Admitted to Intensive Care Unit for Acute Exacerbation of Idiopathic Pulmonary Fibrosis

2004 ◽  
Vol 11 (2) ◽  
pp. 117-122 ◽  
Author(s):  
Fahad M Al-hameed ◽  
Sat Sharma
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Acute Respiratory Failure ◽  
Acute Exacerbation ◽  
Icu Admission ◽  
End Point

RATIONALE:The aim of this study was to evaluate the outcome of intensive care unit (ICU) admission in patients with idiopathic pulmonary fibrosis (IPF) who develop acute respiratory failure of unknown etiology.METHODS:A retrospective study at University of Manitoba hospitals reviewed all patients admitted to the ICU from November 1988 to December 2000 with IPF requiring mechanical ventilation for unknown causes of acute respiratory failure. Survival at hospital discharge was assessed as the primary end point and ICU length of stay as a secondary end point. In the absence of open lung biopsy, major and minor clinical criteria (as per American Thoracic Society statements) were used for the diagnosis of IPF. Infections were ruled out by extensive surveillance cultures and/or bronchoscopy with bronchoalveolar lavage.RESULTS:Eighty-eight charts were reviewed and 25 patients met the inclusion criteria. The mean (± SD) age was 69±11 years (range 42 to 96 years) and 23 patients were male. With the exception of one survivor who was discharged home, 21 patients died while receiving mechanical ventilation, and three patients died in hospital shortly after ICU discharge (one day, 22 days and 67 days). Intubation and mechanical ventilation were administered to 21 patients, with a mean duration of 11±6 days (range two to 27 days); the other four patients were treated with noninvasive ventilation. The average duration of symptoms before ICU admission was 22±26 days. All patients were treated with systemic corticosteroids, while eight patients received additional chemotherapy.CONCLUSIONS:In the absence of a reversible cause, patients with IPF who develop acute exacerbation of IPF may not benefit from ICU admission and mechanical ventilation. However, it is imperative that a diagnostic workup be performed to rule out an infectious or other reversible cause of respiratory failure before admission to the ICU is denied.

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