Acute respiratory failure in critically ill patients with interstitial lung disease

• Published in: PloS one 2014-08, Vol.9 (8), p.e104897-e104897
• Main Authors: Zafrani, Lara, Lemiale, Virginie, Lapidus, Nathanael, Lorillon, Gwenael, Schlemmer, Benoît, Azoulay, Elie
• Format: Article
• Language: English
• Subjects: Acute Disease; Adrenal Cortex Hormones - therapeutic use; Aged; Biology and Life Sciences; Biopsy; Computed tomography; Confidence intervals; Corticosteroids; Critical Illness; Disease control; Echocardiography; Female; Fibrosis; Hospital Mortality; Humans; Hypertension; Intensive care; Logistic Models; Lung diseases; Lung Diseases, Interstitial - complications; Lung Diseases, Interstitial - therapy; Male; Medical prognosis; Medicine and Health Sciences; Middle Aged; Mortality; Paris - epidemiology; Patients; Pneumonia; Positive-Pressure Respiration; Pulmonary fibrosis; Pulmonary hypertension; Respiration, Artificial; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - mortality; Respiratory Distress Syndrome, Adult - therapy; Respiratory failure; Respiratory Insufficiency - etiology; Respiratory Insufficiency - mortality; Respiratory Insufficiency - therapy; Respiratory therapy; Retrospective Studies; Statistical analysis; Steroid hormones; Steroids; Therapy; Tomography; Ventilation; Ventilators
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0104897

Patients with chronic known or unknown interstitial lung disease (ILD) may present with severe respiratory flares that require intensive management. Outcome data in these patients are scarce. Clinical and radiological features were collected in 83 patients with ILD-associated acute respiratory failure (ARF). Determinants of hospital mortality and response to corticosteroid therapy were identified by logistic regression. Hospital and 1-year mortality rates were 41% and 54% respectively. Pulmonary hypertension, computed tomography (CT) fibrosis and acute kidney injury were independently associated with mortality (odds ratio (OR) 4.55; 95% confidence interval (95%CI) (1.20-17.33); OR, 7.68; (1.78-33.22) and OR 10.60; (2.25-49.97) respectively). Response to steroids was higher in patients with shorter time from hospital admission to corticosteroid therapy. Patients with fibrosis on CT had lower response to steroids (OR, 0.03; (0.005-0.21)). In mechanically ventilated patients, overdistension induced by high PEEP settings was associated with CT fibrosis and hospital mortality. Mortality is high in ILD-associated ARF. CT and echocardiography are valuable prognostic tools. Prompt corticosteroid therapy may improve survival.