HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text (PDF) All Versions of this Article: chest.07-1481v1 133/5/1113    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fernández-Pérez, E. R. Articles by Gajic, O. Search for Related Content PubMed PubMed Citation Articles by Fernández-Pérez, E. R. Articles by Gajic, O. Related Content Related Editorial

Ventilator settings and outcome of respiratory failure in chronic interstitial lung disease

Evans R. Fernández-Pérez, M.D., Instructor in Medicine, Fellow, Pulmonary and Critical Care Medicine^, Mayo Clinic College of Medicine, Rochester, MN; Murat Yilmaz, M.D., Research fellow, Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN; Hussam Jenad, M.D., Fellow, Hospital Medicine, Mayo Clinic College of Medicine, Rochester, MN; Craig E. Daniels, M.D., Assistant Professor of Medicine, Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN; Jay H. Ryu, M.D. FCCP, Professor of Medicine, Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN; Rolf D Hubmayr, M.D. FCCP, Professor of Medicine, Walter and Leonore Annenberg Professor in Cardiology and Critical Care, Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN; Ognjen Gajic, M.D., MSc. FCCP, Assistant Professor of Medicine, Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN

Abstract

BackgroundWhile patients with interstitial lung disease may be particularly susceptible to ventilator-induced lung injury, ventilator strategies have not been studied in this group of patients.

PurposeTo describe the clinical course and outcome of patients with interstitial lung disease and acute respiratory failure in relation to ventilatory parameters.

MethodsWe retrospectively identified a cohort of ventilated patients with interstitial lung disease admitted to five ICUs at a single institution. We analyzed demographic data, pulmonary function tests, severity of illness, and initial 24 hours of continuous ventilator parameters. Primary outcomes were survival to hospital discharge and one-year survival.

Main resultsOf 94 patients with interstitial lung disease, 44(47%) survived to hospital discharge and 39(41%) were alive at one-year. Non-survivors were less likely to be postoperative, had higher severity of illness and were ventilated at higher airway pressures and lower tidal volumes. Step changes in positive end-expiratory pressure >10 cmH2O were attempted in 20 patients and resulted in an increase in plateau pressure (median difference +16; IQR, 9 to 24 cm H₂O) and a decrease in respiratory system compliance (median difference -0.28: IQR, -0.43 to -0.13 mL/kg/cm H₂O). Cox model revealed high positive end-expiratory pressure (hazard ratio 4.72; 95% CI, 2.06, 11.15), APACHE III predicted mortality (hazard ratio 1.33; 95% CI, 1.18, 1.50), age (hazard ratio 1.03; 95% CI, 1, 1.05) and low PaO₂/FiO₂ (hazard ratio 0.96; 95% CI, 0.92, 0.99) to be independent determinants of survival.

ConclusionBoth severity of illness and high PEEP settings are associated with decreased survival of interstitial lung disease patients receiving mechanical ventilation.

Key Words: Interstitial lung disease • intensive care unit • respiration • artificial

Related Editorial

Mechanical Ventilation in Interstitial Lung Disease: Which Patients Are Likely to Benefit?

Ahmet Baydur
Chest 2008 133: 1062-1063. [Full Text] [PDF]

This article has been cited by other articles:

				A. Baydur Mechanical Ventilation in Interstitial Lung Disease: Which Patients Are Likely to Benefit? Chest, May 1, 2008; 133(5): 1062 - 1063. [Full Text] [PDF]