Abstract
Background: Acute exacerbation (AE) is a severe complication of idiopathic pulmonary fibrosis (IPF), and the short-term prognosis is poor. Recently, the new definition has been published in acute respiratory distress syndrome (ARDS), which requires minimal positive end-expiratory pressure (PEEP) level for assessing gas exchange. However, the clinical utility of PEEP in AE-IPF has not been sufficiently elucidated.
Aims and objectives: To evaluate the clinical utility of low PEEP using non-invasive positive pressure ventilation (NPPV) in AE-IPF.
Methods: AE-IPF was defined according to the criteria established by Collard et al. (AJRCCM 2007; 176: 636-643). We retrospectively analyzed the data of 50 AE-IPF patients.
Results: The median PaO2/FiO2 (P/F) before and 30 minutes after NPPV (low PEEP=4-5 cmH2O) were 242 and 433, respectively (p<0.001). We classified AE-IPF as mild group (P/F>300 with low PEEP, n=40) and severe group (P/F≤300 with low PEEP, n=10). The Kaplan-Meier curves revealed significantly worse survival among severe group than mild group (log-rank test p=0.010). With univariate Cox proportional analysis, “severe group” and several variables had statistically significant impacts on survival. With multivariate Cox proportional analysis, KL-6 (HR=1.370), D-dimer (HR=1.038), % neutrophils in BAL fluid (HR=1.027) and “severe group” (HR=3.706) had statistically significant impacts on survival up to 90 days.
Conclusions: Low PEEP using NPPV improved oxygenation immediately in majority of patients with AE-IPF. The severity of oxygenation with low PEEP was a statistically significant predictor on survival up to 90 days in AE-IPF.
- Idiopathic pulmonary fibrosis
- Interstitial lung disease
- Non-invasive ventilation - acute respiratory failure
- Copyright ©ERS 2015