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Original Research: CRITICAL CARE MEDICINE |

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

Evans R. Fernández-Pérez, MD; Murat Yilmaz, MD; Hussam Jenad, MD; Craig E. Daniels, MD; Jay H. Ryu, MD, FCCP; Rolf D. Hubmayr, MD, FCCP; Ognjen Gajic, MD, MSc, FCCP
Author and Funding Information

*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@mayo.edu



Chest. 2008;133(5):1113-1119. doi:10.1378/chest.07-1481
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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.

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