Role of Non-invasive Ventilation in Managing Life-threatening Acute Exacerbation of Interstitial Pneumonia

Introduction Invasive mechanical ventilation (IMV) is not effective for acute exacerbation of interstitial pneumonia (AE-IP); however, the role of non-invasive ventilation (NIV) for this condition remains unknown. Methods Comparisons were made for two periods: before (October 2001 - September 2003) and after (October 2004 - September 2006) the introduction of NIV as the primary method of mechanical ventilation for AE-IP. We retrospectively screened emergent admissions and enrolled consecutively those patients with AE-IP who had acutely worsening hypoxemia with new infiltrates, background chronic interstitial CT changes, and no findings suggestive of other diseases. The two periods were compared primarily for 60-day survival and secondarily for other outcomes associated with mechanical ventilation. Results Medical records were retrieved for 11 episodes in 11 patients identified from 485 pre-NIV records and 27 episodes in 22 patients from 859 post-NIV records. Five patients required IMV in the earlier cohort and 9 patients received NIV in the later cohort. Although there was no difference in the PaO(2)/FiO(2) ratio on admission (167 vs. 139), the 60-day survival rate for all episodes in the later cohort was better than in the earlier cohort (27% vs. 65%, p=0.02). Moreover, the NIV-administered group had a better 60-day survival rate (0% vs. 44%, p=0.03), shorter high-care unit stay (17 vs. 6 days, p=0.03) and better-preserved verbal communication (0 vs., 89%) than the IMV-administered group. Conclusion Use of NIV in place of IMV for the management of life-threatening AE-IP appears to result in a better 60-day survival rate, lower high-care unit use and better patient tolerability.