Non-invasive mechanical ventilation in patients with diffuse interstitial lung diseases

BMC Pulmonary Medicine

Alberto Pesci⁶  Antonio Esquinas⁷  Antonio Voza⁸  Sergio Harari⁴  Francesca Luisi⁴  Mauro Carone⁹  Raffaele Scala¹  Francesco Blasi⁵  Anna Maria Brambilla^1,10  Roberto Cosentini^1,10  Fabio Giuliani⁵  Vanni Galavotti²  Dina Visca³  Sveva Maggiolini⁶  Silvia Gamberini⁶  Grazia Messinesi⁶  Stefano Aliberti⁶ 

[1]Pulmonary Unit and Respiratory Intensive Care Unit, Ospedale S. Donato, Via P. Nenni, 20, Arezzo, Italy

[2]SC di Pneumologia e UTIR, Azienda Ospedaliera C. Poma, Mantova, Italy

[3]Department of Clinical and Experimental Medicine, Respiratory Disease Unit, University of Parma, Parma, Italy

[4]U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe - MultiMedica, Milan, Italy

[5]Dipartimento di Fisiopatologia e dei Trapianti, University of Milan, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy

[6]Department of Health Science, Clinica Pneumologica, AO San Gerardo, University of Milan Bicocca, Via Pergolesi 33, Monza, Italy

[7]Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain

[8]Emergency Medicine Department, Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy

[9]Divisione di Pneumologia, IRCCS Fondazione Salvatore Maugeri, Istituto Scientifico di Cassano delle Murge, Bari, Italy

[10]Emergency Medicine Department, IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy

关键词: Ventilation;    Continuous positive airway pressure;    Pneumonia;    Interstitial lung disease;    Non-invasive ventilation;    Diffuse parenchymal lung disease;    Fibrosis;   

Others  :  1090989
DOI  :  10.1186/1471-2466-14-194

 received in 2013-12-23, accepted in 2014-12-01,  发布年份 2014

【 摘 要 】

Background

To evaluate noninvasive ventilation (NIV) in diffuse interstitial lung diseases (DILD) patients with acute respiratory failure (ARF) according to baseline radiological patterns and the etiology of ARF.

Methods

In a multicenter, observational, retrospective study, consecutive DILD patients undergoing NIV because of an episode of ARF were evaluated in six Italian high dependency units. Three groups of patients were identified based on the etiology of ARF: those with pneumonia (Group A), those with acute exacerbation of fibrosis, (Group B) and those with other triggers (Group C). Clinical failure was defined as any among in-hospital mortality, endotracheal intubation and extra-corporeal membrane oxygenation use.

Results

Among the 60 patients enrolled (63% males; median age: 71 years), pneumonia (42%) and acute exacerbation of fibrosis (39%) were the two most frequent causes of ARF. A significant increase of PaO₂/FiO₂ ratio during NIV treatment was detected in Group A (p = 0.010), but not in Group B. No significant difference in PaO₂/FiO₂ ratio, PaCO₂ and pH values during NIV treatment was detected in patients with a radiological pattern of usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP). 22 patients (37%) suffered for a clinical failure. No significant differences in the study outcome were detected in Group A vs. Group B, as well as among patients with a radiological pattern of UIP vs. NSIP.

Conclusions

NIV treatment should be individualized in DILD patients with ARF according to the etiology, but not the baseline radiological pattern, in order to improve oxygenation.

【 授权许可】

   
2014 Aliberti et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 1.

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