Mechanical ventilation for acute respiratory failure due to idiopathic pulmonary fibrosis versus connective tissue disease-associated interstitial lung disease: Effectiveness and risk factors for death.

Abstract

Relatively little is known about the effects of mechanical ventilation (MV; including invasive MV [IMV] and noninvasive ventilation) on clinical outcomes of patients with idiopathic pulmonary fibrosis (IPF) and connective tissue disease-associated interstitial lung disease (CTD-ILD) in the intensive care unit (ICU) and risk factors for ICU death remain to be determined. Our objective was to determine and compare mortality rates between IPF and CTD-ILD patients receiving MV and to identify risk factors for ICU death in these patients. We conducted a retrospective cohort study in respiratory ICUs of three university hospitals in China during a 7-year period. We compared clinical data and outcomes between patients with IPF and those with CTD-ILD and performed logistic regression analyses to identify risk factors for ICU death. Of the 94 patients in the analyses, 63 were diagnosed with IPF and 31 were diagnosed with CTD-ILD. ICU mortality was significantly higher in the IPF group than in the CTD-ILD group (86% vs 68%; P=0.041) and was significantly lower in patients receiving noninvasive ventilation than in those receiving IMV (62% vs 88%; P=0.004). Risk factors for ICU death were disease progression as the principal cause of acute respiratory failure and IMV. Based on current clinical practice in three ICUs, the mortality rate in IPF patients receiving MV might reach 86% and is higher than in CTD-ILD patients. IMV might be initiated cautiously, especially in patients with disease progression as the principal cause of acute respiratory failure.