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

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.

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

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.

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

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.

Outcome of Patients with Interstitial Lung Disease Treated with Extracorporeal Membrane Oxygenation for Acute Respiratory Failure

2016 ◽  
Vol 193 (5) ◽  
pp. 527-533 ◽  
Author(s):  
Franziska C. Trudzinski ◽  
Franziska Kaestner ◽  
Hans-Joachim Schäfers ◽  
Sebastian Fähndrich ◽  
Frederik Seiler ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Interstitial Lung Disease ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Lung Disease ◽  
Membrane Oxygenation

scholarly journals Clinical outcomes of patients receiving prolonged extracorporeal membrane oxygenation for respiratory support

2019 ◽  
Vol 13 ◽  
pp. 175346661984894 ◽  
Author(s):  
Soo Jin Na ◽  
Jae-Seung Jung ◽  
Sang-Bum Hong ◽  
Woo Hyun Cho ◽  
Sang-Min Lee ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Ecmo Support ◽  
Respiratory Support ◽  
Short Term ◽  
Membrane Oxygenation

Background: There are limited data regarding prolonged extracorporeal membrane oxygenation (ECMO) support, despite increase in ECMO use and duration in patients with respiratory failure. The objective of this study was to investigate the outcomes of severe acute respiratory failure patients supported with prolonged ECMO for more than 28 days. Methods: Between January 2012 and December 2015, all consecutive adult patients with severe acute respiratory failure who underwent ECMO for respiratory support at 16 tertiary or university-affiliated hospitals in South Korea were enrolled retrospectively. The patients were divided into two groups: short-term group defined as ECMO for ⩽28 days and long-term group defined as ECMO for more than 28 days. In-hospital and 6-month mortalities were compared between the two groups. Results: A total of 487 patients received ECMO support for acute respiratory failure during the study period, and the median support duration was 8 days (4–20 days). Of these patients, 411 (84.4%) received ECMO support for ⩽28 days (short-term group), and 76 (15.6%) received support for more than 28 days (long-term group). The proportion of acute exacerbation of interstitial lung disease as a cause of respiratory failure was higher in the long-term group than in the short-term group (22.4% versus 7.5%, p < 0.001), and the duration of mechanical ventilation before ECMO was longer (4 days versus 1 day, p < 0.001). The hospital mortality rate (60.8% versus 69.7%, p = 0.141) and the 6-month mortality rate (66.2% versus 74.0%, p = 0.196) were not different between the two groups. ECMO support longer than 28 days was not associated with hospital mortality in univariable and multivariable analyses. Conclusions: Short- and long-term survival rates among patients receiving ECMO support for more than 28 days for severe acute respiratory failure were not worse than those among patients receiving ECMO for 28 days or less.

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

2020 ◽  
Vol 14 ◽  
pp. 175346662092695
Author(s):  
Wei-Ling Lain ◽  
Shi-Chuan Chang ◽  
Wei-Chih Chen
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Interstitial Lung Disease ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Lung Disease ◽  
Medical Center ◽  
Pulse Therapy ◽  
Outcome Data

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.

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

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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