• Corrado Mollica, Gregorino Paone, Vittoria Conti, Daniela Ceccarelli, Giovanni Schmid, Paolo Mattia, Nicola Perrone, Angelo Petroianni, Alfredo Sebastiani, Luca Cecchini, Remo Orsetti, and Claudio Terzano.
• Respiratory Intermediate Intensive Care Unit, S. Camillo-Forlanini Hospital, Rome, Italy.
• Respiration. 2010 Jan 1;79(3):209-15.

BackgroundAcute respiratory failure (ARF) occurring during idiopathic pulmonary fibrosis (IPF) is associated with a poor prognosis. In this subset of individuals, mechanical ventilation (MV) may be required.ObjectivesWe analysed the characteristics of a group of IPF patients undergoing MV for ARF in order to give some indications on the supposed prognosis.MethodsHospital records of 34 consecutive patients with IPF, who underwent MV for ARF, were retrospectively examined. Demographic data, time from diagnosis, gas exchange, Acute Physiology and Chronic Health Evaluation (APACHE) II score, ARF causes and MV failure were recorded.ResultsFifteen subjects (group A) underwent invasive MV and 19 patients (group B) non-invasive ventilation (NIV). The 2 groups were different for disease severity (APACHE II score 24.2 +/- 6 vs. 19.5 +/- 5.9; p = 0.01). Both ventilatory strategies temporarily increased PaO2/FiO2 as compared with spontaneous breathing (group A: 148.5 +/- 52 vs. 99 +/- 39, p = 0.0004; group B: 134 +/- 36 vs. 89 +/- 26, p = 0.0004). NIV reduced the respiratory rate (26 +/- 7 vs. 36 +/- 9 with spontaneous breathing; p = 0.002). Duration of MV correlated with the time of evolution of IPF (r = 0.45; p = 0.018). The in-hospital mortality rate was 85% (100% for invasive MV, 74% for NIV). Four of the 5 survivors died within 6 months from hospital discharge (range 2-6 months).ConclusionsMV does not appear to have a significant impact on the survival of patients with end-stage IPF. NIV may be useful for compassionate use, providing relief from dyspnoea and avoiding aggressive approaches.Copyright 2009 S. Karger AG, Basel.

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