INTERSTITIAL LUNG DISEASE-ASSOCIATED ACUTE RESPIRATORY FAILURE REQUIRING INVASIVE MECHANICAL VENTILATION: A RETROSPECTIVE ANALYSIS

Abstract

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Interstitial lung disease (ILD) patients requiring invasive mechanical ventilation (IMV) for acute respiratory failure (ARF) are known to have a poor prognosis. The objective of this retrospective study is to investigate in-hospital and 1-year mortality outcomes and to identify determinants of mortality between ILD-ARF patients. METHODS: We retrospectively investigated ILD patients requiring IMV for ARF in 4 different ICUs at a single institution. We analyzed demographic data, patient baseline characteristics, ILD subtype, ventilator settings, echocardiography and ICU level interventions. Primary outcomes were survival to hospital discharge and one-year survival in patients trialed on NIPPV prior to IMV and in patients treated with IMV only. RESULTS: Of the 54 ILD patients with ARF treated with mechanical ventilation, 20 (37.0%) survived to hospital discharge and 10 (18.5%) were alive at one-year. No mortality difference was observed in patients who were trialed on NIPPV prior to IMV versus those only treated with IMV. In-hospital mortality was higher with increased body mass index, idiopathic pulmonary fibrosis subtype (IPF), vasopressor use, stress or pulse steroid use, and ventilator settings with increased respiratory rate, PEEP, FiO2, and mean airway pressure. 1-year mortality rates were higher in patients with IPF, higher mean airway pressure, and vasopressor use. 1-year mortality rates were lower in patients with connective tissue disease. Determinants of 1-year mortality amongst patients undergoing NIPPV prior to IMV versus IMV only included: age older than 65 is associated with increased mortality in the NIPPV prior to IMV cohort; and patients without pulmonary hypertension (PH) is associated with increased mortality in the NIPPV prior to IMV cohort. Main characteristics were analyzed for management trends and notable findings included: volume control ventilation was the most common IMV mode used (58.5%); re-intubation and tracheostomy was seen in 18.0% and 18.5% of patients, respectively; lung transplant consideration was observed in 21.6% of patients; and palliative care consultation was observed in 48.8% of patients. CONCLUSIONS: The in-hospital and 1-year mortality rate of ILD-ARF requiring IMV is extremely high. Determinants of mortality correlate with more aggressive interventions and increased ventilator support settings. CLINICAL IMPLICATIONS: Considering that patients trialed on NIPPV prior to IMV has no mortality disadvantage to patients treated with IMV only, trialing patients on NIPPV may identify responders and avoid negative hemodynamic effects of IMV. PH had no impact on mortality, likely indicating that ILD is a complex process with wide morphological variability. The use of increased ventilator support, vasopressors, and high dose steroids reflect higher mortality and palliative care involvement should be considered as early as possible if lung transplant is not an option. DISCLOSURES: No relevant relationships by Olayiwola Amoran, source=Web Response No relevant relationships by Paul Kinniry, source=Web Response No relevant relationships by Alexander Pichler, source=Web Response No relevant relationships by cyrus vahdatpour, source=Web Response