3.8 Article

Prognostic evaluation by oxygenation with positive end-expiratory pressure in acute exacerbation of idiopathic pulmonary fibrosis: A retrospective cohort study

Journal

CLINICAL RESPIRATORY JOURNAL
Volume 12, Issue 3, Pages 895-903

Publisher

WILEY
DOI: 10.1111/crj.12602

Keywords

acute respiratory distress syndrome; idiopathic pulmonary fibrosis; positive end-expiratory pressure; acute exacerbation; mechanical ventilation

Funding

  1. Respiratory Failure Research Group from the Ministry of Health, Labour, and Welfare, Japan
  2. NPO Respiratory Disease Conference

Ask authors/readers for more resources

IntroductionAcute exacerbation (AE) is a severe complication of idiopathic pulmonary fibrosis (IPF), which shares some common pathological features with acute respiratory distress syndrome (ARDS). The new definition of ARDS requires positive end-expiratory pressure (PEEP) to assess gas exchange and has better predictive validity for short-term mortality compared with the previous definition. ObjectivesThe aim of this study was to evaluate the prognostic utility of oxygenation with PEEP in AE-IPF. MethodsWe performed a retrospective cohort study using the data of AE-IPF patients between 2007 and 2015. At the time of diagnosis, PaO2/FiO(2) was evaluated before and 30 minutes after PEEP. We evaluated the prognostic utility of PaO2/FiO(2) with PEEP after including other candidate prognostic factors. Considering the definition of ARDS, patients with AE-IPF were classified into a severe group (PaO2/FiO(2)300 with PEEP) and a non-severe group (PaO2/FiO(2)>300 with PEEP). ResultsWe identified 62 consecutive patients with AE-IPF. All patients were treated with mechanical ventilation on the first day. The median PaO2/FiO(2) before and 30 minutes after PEEP was significantly increased (237.5-425.5, P<.001). In multivariate Cox proportional analysis, Krebs von den Lungen-6 (KL-6) (HR 1.239; 95%CI 1.050-1.461; P=.011), D-dimer (HR 1.039; 95%CI 1.015-1.064; P=.001), % neutrophils in bronchoalveolar lavage fluid (HR 1.015; 95%CI 1.003-1.027; P=.017), and being in the severe group (HR 3.233; 95%CI 1.503-6.957; P=.003) had significant impacts on survival up to 90 days. ConclusionEvaluation of oxygenation with PEEP may provide useful information for predicting short-term mortality in patients with AE-IPF.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

3.8
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available