Study objective: To evaluate the beneficial effect of
mechanical ventilation (MV) in patients with idiopathic pulmonary
fibrosis (IPF) who develop acute respiratory failure (ARF), with
special emphasis on prognosis.
Setting: Ten-bed respiratory ICU that is a part
of a respiratory department actively involved in lung transplantation
Patients: From 1991 to 1999, 23 patients (mean
age, 52.9 years; range, 21 to 82 years) with IPF required MV for ARF.
At admission to the ICU, 16 patients were potential candidates for LTx,
with 5 patients already on the waiting list.
and results: Survival and gas exchange under MV were assessed.
The precipitating cause of ARF was also analyzed. With the exception of
1 patient who successfully received a single-lung transplant 6 h
after initiation of MV, all the remaining 22 patients died while
receiving MV (median survival, 3 days; range, 1 h to 60 days). The
duration of MV correlated positively with baseline vital capacity
(percent predicted) (R = 0.54; p = 0.01) and
baseline total lung capacity (percent predicted)
(R = 0.71; p < 0.001), and correlated negatively
with baseline Paco2
(R = − 0.47; p = 0.03) and the duration of
evolution of IPF (R = −0.50; p = 0.01). Duration of
MV did not correlate with the duration of immunosuppressive therapy
(R = − 0.24; p = 0.27) or duration of oxygen
therapy (R = − 0.32; p = 0.14) prior to admission.
The precipitating cause of ARF was most often not identified.
Conclusions: Our data support the general belief that MV
does not benefit IPF patients presenting with ARF. Initiation of MV in
IPF patients is thus questionable and should, in our opinion, be
restricted to patients in whom LTx can be performed within a few days
after initiation of MV.