Non-invasive ventilation (NIV) in acute respiratory failure in patients with idiopathic pulmonary fibrosis (IPF)

Abstract

Introduction: A limited number of observational studies have reported that NIV can be an effective treatment in IPF. We aimed to investigate outcomes in IPF patients receiving NIV for ARF and to identify risk factors for its failure. Methods: A retrospective analysis of outcome in IPF patients being administered NIV for ARF in an 8-bed medical ICU. 28 IPF patients who were administered NIV between January 1st, 2007and December 31st, 2014, were included. The outcome measures were, need for endotracheal intubation, length of stay and ICU mortality. Multivariate analysis was performed to identify factors associated to NIV failure. Results: Patients were 64±15,62 years mean-aged. Disease duration was 3,55±3 years. 53% have poor baseline functional status(NYHA ≥III). Diagnoses at admission were, fibrosis exacerbation, 16; infectious decompensation, 2 and cardiac decompensation, 8. SAPSII score was 34.85±11. NIV was successful in 12 patients and failed in 16. All the patients in the NIV failure group died within 5.53±6.05 days. The patients in the NIV success group spent 7.75±6.01 days in the ICU and all survived. At admission, the patients in the failure group had significantly higher plasma NT-proBNPlevels (2847±2004vs 600±660 pg/mL;p=0.032) and significantly lower PaO2/FiO2ratio (135.62±67.75 vs 300.5±82.82; p=0.031). NIV failure was associated to the plasma NT-proBNP levels (OR, 5.81;95%CI, [4.20 , 10.08] ; p=0.032). Conclusion: The outcome of IPF patients who were administered NIV was quite poor. The use of NIV was, nevertheless, found to be associated with clinical benefits. Elevated plasma NT-proBNP levels may be a simple marker for poor NIV outcome.