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Evans R. Fernández-Pérez, MD, MSc; Ognjen Gajic, MD, MSc
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Fernández-Pérez), Department of Internal Medicine, National Jewish Health; and the Division of Pulmonary and Critical Care Medicine (Dr Gajic), Department of Internal Medicine, Mayo Clinic College of Medicine.

Correspondence to: Evans R. Fernández Pérez, MD, MSc, Assistant Professor of Medicine, Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, 400 Jackson St G-10a, Denver, CO, 80206; e-mail: FernandezEvans@NJHealth.org


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):242. doi:10.1378/chest.09-1871
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To the Editor:

We appreciate the interest of Paone et al in our recent article in CHEST (May 2008),1 which aimed to describe the clinical course and outcome of patients with interstitial lung disease and acute respiratory failure in relation to ventilatory parameters. The inhospital mortality after acute respiratory worsening in patients with idiopathic pulmonary fibrosis (IPF) requiring mechanical ventilation in our study was high (60%), but not as high as that found in the study by Mollica et al2 (85%). As pointed out, the difference is likely the result of systematic methodological differences (ie, higher number of postoperative respiratory failures, different patient inclusion criteria and study definitions).

The baseline severity of illness is the most important outcome determinant. Despite the poor hospital survival, some patients with IPF, especially postsurgical patients undergoing mechanical ventilation, can survive an acute exacerbation1—thus the importance of identifying a treatable cause for the exacerbation.

Patients with IPF are clearly at increased risk for ventilator-induced lung injury.3 Our findings suggest that patients with fibrotic lung disease and especially those with advanced IPF may be harmed by lung recruitment maneuvers and high positive end-expiratory pressure commonly used to improve oxygenation. The determination of which patients are most likely to benefit from mechanical ventilation, as well as the optimal ventilatory strategy, awaits further investigation.

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. In press.
 
Dreyfuss D, Saumon G. Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med. 1998;1571:294-323. [PubMed]
 

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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. In press.
 
Dreyfuss D, Saumon G. Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med. 1998;1571:294-323. [PubMed]
 
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