MECHANICAL VENTILATION FOR INTERSTITIAL LUNG DISEASE BY SYSTEMIC SCLEROSIS WITH CREST SYNDROME. PRESENTATION OF A CLINICAL CASE

2021 ◽  
pp. 80-81
Author(s):  
Katherine Esparza Maquilón ◽  
Antonio Miguel Ornes Rodriguez ◽  
Diana Mercedes Bombón Salazar ◽  
Daniela Macarena Mediavilla Paredes ◽  
Luis Gustavo Mediavilla Sevilla ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Systemic Sclerosis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Crest Syndrome ◽  
Positive Skin ◽  
Lung Protection ◽  
Advanced Stages

INTRODUCTION. Interstitial lung disease (ILD) with acute respiratory failure needs ventilatory support poorly documented. One of the interstitial diseases known is the Systemic sclerosis, its advanced stages develop CREST syndrome. Faverio P, et al. (2016) suggested do not close the door to these patients and open the correct protocol, criticizing the little value that the scientic community concede to invasive mechanical ventilation (IMV). CASE REPORT. 85-year-old male is internalized in critical care unit by pneumonia, the complementary evaluation shows a systemic sclerosis disease with CREST syndrome and it is conrmed by elevation of anti-centromere antibody and positive skin biopsy. Tomography highlights pneumonic consolidation plus interstitial lung involvement and echocardiography reveals pulmonary hypertension. The management is done with IMV, keeping the goal of driving pressure less than 15 as lung protection, recovering respiratory function in 3 weeks. Discussion. The evidence is too insufcient to establish the best decision on IMV to the management of ILD.

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

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.

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

2020 ◽  
Vol 14 (1) ◽  
pp. 67-77
Author(s):  
Cyrus A. 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

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: A retrospective study was designed using patients at four different intensive care units within one health care system. The 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: Out of 54 ILD patients with ARF treated with IMV, 20 (37.0%) survived until 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. Conclusion: Considering that patients trialed on NIPPV prior to IMV were 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 a lung transplant is not an option.

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

2020 ◽  
Author(s):  
Cyrus A. 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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