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Early Intervention Can Improve Clinical Outcome of Acute Interstitial Pneumonia^*

Gee Young Suh, MD; Eun Hae Kang, MD; Man Pyo Chung, MD; Kyung Soo Lee, MD; Joungho Han, MD; Masanori Kitaichi, MD and O Jung Kwon, MD

^* From the Departments of Medicine (Drs. Suh, Kang, Chung, Kwon), Radiology (Dr. Lee), and Pathology (Dr. Han), Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; and the Laboratory of Anatomic Pathology (Dr. Kitaichi), Kyoto University Hospital, Kyoto, Japan. These authors contributed equally to this work.

Correspondence to: Man Pyo Chung, MD, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135–710 South Korea; e-mail: mpchung{at}smc.samsung.co.kr

Abstract

Study objectives: To report on our experience with acute interstitial pneumonia (AIP) in which patients underwent early diagnostic procedures and received mechanical ventilation with a "lung-protective" strategy and early institution of immunosuppressive therapy.

Design: A retrospective chart review.

Setting: A tertiary referral hospital.

Participants: Ten patients with AIP who presented with idiopathic ARDS and showed diffuse alveolar damage on surgical lung biopsy specimens from July 1995 to March 2004.

Measurements and results: The median age of patients was 65.5 years (age range, 38 to 73 years). Patients presented with a median duration of severe dyspnea of 9.5 days (range, 2 to 34 days) at the hospital visit. All patients required mechanical ventilation beginning at median time of hospital day 1 (range, hospital day 0 to 5), which continued for a median duration of 9.5 days (range, 4 to 98 days). Patients received ventilation in the pressure assist-control mode with a median tidal volume of 6.97 mL/kg (range, 6.05 to 8.86 mL/kg) and median positive end-expiratory pressure of 11 cm H₂O (range, 8 to 16 cm H₂O). An aggressive diagnostic workup for respiratory infection, including BAL at a median time of hospital day 2 (range, hospital day 1 to 5) was performed. High-dose steroid pulse therapy was initiated on median hospital day 3.5 (range, hospital day 1 to 8), while surgical lung biopsy was performed on median hospital day 4 (range, hospital day 2 to 7). Eight patients (80%) survived to hospital discharge.

Conclusion: Earlier intervention, such as an aggressive diagnostic approach, mechanical ventilation with lung-protective strategy, and the early institution of immunosuppressive may improve clinical outcome in patients with AIP.

Key Words: acute interstitial pneumonia • ARDS • corticosteroids • diffuse alveolar damage

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