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Outcome of Patients With Idiopathic Pulmonary Fibrosis Admitted to the ICU for Respiratory Failure^*

^* From the Service de Réanimation Médicale, (Drs. Blivet, Philit, Sab, Langevin, Guérin, and Robert), Hôpital de la Croix Rousseand; and Service de Radiologie (Dr. Paret), Hôpital Louis Pradel, Lyon, France.

Correspondence to: François Philit, MD, Service de Réanimation Médicale, Hôpital de la Croix Rousse, 69317 Lyon Cedex 04, France; e-mail: francois.philit{at}chu-lyon.fr

Study objectives: To analyze the outcome of acute respiratory failure (ARF) in patients with idiopathic pulmonary fibrosis (IPF), and to evaluate the benefits of invasive and noninvasive mechanical ventilation (MV).

Design: Retrospective study.

Setting: University hospital.

Patients: Fifteen consecutive patients with IPF referred to the ICU for ARF between January 1989 and June 1998.

Measurements and results: Fifteen patients (mean ± SD age, 64 ± 10 years) were included. Eight patients had clinical, functional, and radiologic features of IPF, and the remaining seven patients also had biopsy specimen-proven IPF. The mean duration between diagnosis of IPF and admission to the ICU was 26.5 ± 28 months. At the time of ICU admission, mean arterial blood gas levels were as follows: PaO₂/fraction of inspired oxygen, 113 ± 95; pH, 7.32 ± 0.10; and PaCO₂, 55 ± 21 mm Hg. All patients received MV; 12 patients required tracheal intubation, either at the time of ICU admission (n = 10) or after failure of noninvasive ventilation (NIV; n = 2); and 3 patients only received NIV. Three of the five patients receiving NIV died of respiratory failure. Eleven patients died in the ICU, either from hypoxemia (n = 8) or from septic shock (n = 3). Four patients were discharged alive from the ICU, and two of them died shortly thereafter.

Conclusion: The outcome of patients with IPF referred to the ICU for ARF was very poor and not improved by MV. Without a clearly identified reversible cause of ARF, these patients should not benefit from admission to the ICU.

Key Words: ICU • idiopathic pulmonary fibrosis • interstitial lung disease • respiratory failure

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