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Ventilator Settings and Outcome of Respiratory Failure in Chronic Interstitial Lung Disease^*

^* From the Departments of Pulmonary and Critical Care Medicine (Drs. Fernández-Pérez, Daniels, Ryu, Hubmayr, and Gajic), Critical Care Medicine (Dr. Yilmaz), and Hospital Medicine (Dr. Jenad), Mayo Clinic College of Medicine, Rochester, MN.

Correspondence to: Evans R. Fernández-Pérez, MD, Mayo Clinic College of Medicine, Pulmonary and Critical Care Medicine, East-18, Mayo Clinic, Rochester, MN 55905; e-mail: fernandez.evans{at}mayo.edu

Abstract

Background: While patients with interstitial lung disease (ILD) may be particularly susceptible to ventilator-induced lung injury, ventilator strategies have not been studied in this group of patients.

Purpose: To describe the clinical course and outcome of patients with ILD and acute respiratory failure in relation to ventilatory parameters.

Methods: We retrospectively identified a cohort of ventilated patients with ILD who had been admitted to five ICUs at a single institution. We analyzed demographic data, pulmonary function test results, severity of illness, and the parameters of continuous ventilation for the initial 24 h after admission to the ICU. Primary outcomes were survival to hospital discharge and 1-year survival.

Main results: Of 94 patients with ILD, 44 (47%) survived to hospital discharge and 39 (41%) were alive at 1 year. Nonsurvivors were less likely to be postoperative, had higher severity of illness, and were ventilated at higher airway pressures and lower tidal volumes. Step changes in positive end-expiratory pressure (PEEP) of > 10 cm H₂O were attempted in 20 patients and resulted in an increase in plateau pressure (median difference, + 16 cm H₂O; interquartile range [IQR], 9 to 24 cm H₂O) and a decrease in respiratory system compliance (median difference, – 0.28 mL/kg/cm H₂O; IQR, – 0.43 to – 0.13 mL/kg/cm H₂O). The Cox proportional hazards model revealed that high PEEP (hazard ratio, 4.72; 95% confidence interval [CI], 2.06 to 11.15), acute physiology and chronic health evaluation (APACHE) III score predicted mortality (hazard ratio 1.33; 95% CI, 1.18 to 1.50), age (hazard ratio, 1.03; 95% CI, 1 to 1.05), and low PaO₂/fraction of inspired oxygen ratio (hazard ratio, 0.96; 95% CI, 0.92 to 0.99) to be independent determinants of survival.

Conclusion: Both severity of illness and high PEEP settings are associated with the decreased survival of patients with ILD who are receiving mechanical ventilation.

Key Words: artificial respiration • ICU • interstitial lung disease

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Mechanical Ventilation in Interstitial Lung Disease: Which Patients Are Likely to Benefit?

Ahmet Baydur
Chest 2008 133: 1062-1063. [Full Text] [PDF]

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				A. Baydur Mechanical Ventilation in Interstitial Lung Disease: Which Patients Are Likely to Benefit? Chest, May 1, 2008; 133(5): 1062 - 1063. [Full Text] [PDF]