0
Correspondence |

Severity of Illness and Outcome in Patients With End-Stage Idiopathic Pulmonary Fibrosis Requiring Mechanical Ventilation FREE TO VIEW

Gregorino Paone, MD; Corrado Mollica, MD; Vittoria Conti, MD; Annarita Vestri, MD; Ilio Cammarella, MD; Gabriele Lucantoni, MD; Alvaro Leone, MD; Claudio Terzano, MD
Author and Funding Information

From the Department of Cardiovascular and Respiratory Sciences (Dr Paone), Respiratory Diseases Unit, Fondazione E. Lorillard Spencer Cenci (Drs Conti and Terzano), Department of Experimental Medicine and Pathology (Dr Vestri), Department Attilio Reali (Dr Cammarella), Sapienza University of Rome; Respiratory Intermediate Intensive Care Unit (Dr Mollica), S. Camillo-Forlanini Hospital (Drs Paone, Lucantone, and Leone); and the Don Gnocchi Foundation S. Maria Della Pace (Dr Paone).

Correspondence to: Dr Gregorino Paone, Department of Cardiovascular and Respiratory Sciences, S. Camillo-Forlanini Hospital, Sapienza University of Rome, Via Portuense 332, 00149 Rome, Italy; e-mail: rpaone1023@yahoo.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(1):241-242. doi:10.1378/chest.09-1745
Text Size: A A A
Published online

To the Editor:

We read with interest the article in CHEST by Fernández-Pérez and coworkers (May 2008),1 who retrospectively evaluated 94 patients with interstitial lung disease (ILD) requiring mechanical ventilation for acute respiratory failure (ARF). The median survival time was 75 days, with idiopathic pulmonary fibrosis (IPF) patients (30 individuals) having a not significantly different outcome. The authors conclude that both severity of illness and high positive end-expiratory pressure (PEEP) levels are associated with increased mortality rate in patients with ILD receiving mechanical ventilation.1 We concur with these findings, and we would like to make further observations.

We retrospectively analyzed 34 consecutive IPF patients undergoing mechanical ventilation for ARF.2 In-hospital and 1-year survival were analyzed as primary outcomes. Similar to Fernández-Pérez and coworkers, baseline demographic and clinical characteristics, lung histology, the last pulmonary function tests before ARF onset, the associated comorbidities, and the parameters of continuous ventilation at admission were evaluated. Severity of illness was calculated using the Acute Physiology and Chronic Health Evaluation II (APACHE II) score.

Five patients (15%) survived and were discharged; one patient was still alive after 1 year. The in-hospital mortality rate observed in our study was different than Fernández-Pérez and coworkers’ results (85% vs 60%), but consistent with previous observations.3,4

A possible explanation for the observed discrepancies could be found in the higher percentage of postoperative ARF reported by Fernández-Pérez et al (47% vs 3%); usually patients considered for surgical procedures have a better performance status and a more stable disease.5 We identified the APACHE score as the only factor associated with higher mortality rate: median = 16, range 12 to 17 in survivors; and 20, range 11 to 32 in nonsurvivors; relative risk = 1.64 (95% CI, 1.15-2.34) (Kaplan-Meier analysis median time = 0 to both groups, log-rank test P = .015). No statistical differences (Mann-Whitney U test) were observed between survivors and nonsurvivors in age (58 years, range 47-76 vs 62 years, range 40-80, respectively), PEEP values (6.5 mm Hg, range 4-10 vs 7 mm Hg, range 5-10, respectively) and baseline PaO2/FiO2 ratio (108, range 70-117 vs 100, range 49-190, respectively).

On the one hand, we agree with Fernandez-Perez and coworkers that patients with IPF have little or no recruitable lung and may be susceptible to overdistension of the relatively intact lung when high PEEP levels are used during mechanical ventilation, leading to ventilator-induced lung injury. On the other hand, in our study the use of PEEP values similar to those employed by Fernandez-Perez et al in the survivors group was associated with a poor prognosis (in-hospital mortality rate: 85%), suggesting that the severity of disease should be considered critical for the outcome.

Fernández-Pérez ER, Yilmaz M, Jenad H, et al. Ventilator settings and outcome of respiratory failure in chronic interstitial lung disease. Chest. 2008;1335:1113-1119. [CrossRef] [PubMed]
 
Mollica C, Paone G, Conti V, et al. Mechanical ventilation in patients with end-stage idiopathic pulmonary fibrosis. Respiration. 2009; In press.
 
Fumeaux T, Rothmeier C, Jolliet P. Outcome of mechanical ventilation for acute respiratory failure in patients with pulmonary fibrosis. Intensive Care Med. 2001;2712:1868-1874. [CrossRef] [PubMed]
 
Blivet S, Philit F, Sab JM, et al. Outcome of patients with idiopathic pulmonary fibrosis admitted to the ICU for respiratory failure. Chest. 2001;1201:209-212. [CrossRef] [PubMed]
 
Mallick S. Outcome of patients with idiopathic pulmonary fibrosis (IPF) ventilated in intensive care unit. Respir Med. 2008;10210:1355-1359. [CrossRef] [PubMed]
 

Figures

Tables

References

Fernández-Pérez ER, Yilmaz M, Jenad H, et al. Ventilator settings and outcome of respiratory failure in chronic interstitial lung disease. Chest. 2008;1335:1113-1119. [CrossRef] [PubMed]
 
Mollica C, Paone G, Conti V, et al. Mechanical ventilation in patients with end-stage idiopathic pulmonary fibrosis. Respiration. 2009; In press.
 
Fumeaux T, Rothmeier C, Jolliet P. Outcome of mechanical ventilation for acute respiratory failure in patients with pulmonary fibrosis. Intensive Care Med. 2001;2712:1868-1874. [CrossRef] [PubMed]
 
Blivet S, Philit F, Sab JM, et al. Outcome of patients with idiopathic pulmonary fibrosis admitted to the ICU for respiratory failure. Chest. 2001;1201:209-212. [CrossRef] [PubMed]
 
Mallick S. Outcome of patients with idiopathic pulmonary fibrosis (IPF) ventilated in intensive care unit. Respir Med. 2008;10210:1355-1359. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543