Abstract
Background: While patients with interstitial lung disease (ILD) may be particularly susceptible to ventilator-induced lung injury, ventilator strategies have not been studied in this group of patients. Purpose: To describe the clinical course and outcome of patients with ILD and acute respiratory failure in relation to ventilatory parameters. Methods: We retrospectively identified a cohort of ventilated patients with ILD who had been admitted to five ICUs at a single institution. We analyzed demographic data, pulmonary function test results, severity of illness, and the parameters of continuous ventilation for the initial 24 h after admission to the ICU. Primary outcomes were survival to hospital discharge and 1-year survival. Main results: Of 94 patients with ILD, 44 (47%) survived to hospital discharge and 39 (41%) were alive at 1 year. Nonsurvivors 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 (PEEP) of > 10 cm H2O were attempted in 20 patients and resulted in an increase in plateau pressure (median difference, + 16 cm H2O; interquartile range [IQR], 9 to 24 cm H2O) and a decrease in respiratory system compliance (median difference, -0.28 mL/kg/cm H2O; IQR, - 0.43 to - 0.13 mL/kg/cm H2O). The Cox proportional hazards model revealed that high PEEP (hazard ratio, 4.72; 95% confidence interval [CI], 2.06 to 11.15), acute physiology and chronic health evaluation (APACHE) III score predicted mortality (hazard ratio 1.33; 95% CI, 1.18 to 1.50), age (hazard ratio, 1.03; 95% CI, 1 to 1.05), and low PaO2/fraction of inspired oxygen ratio (hazard ratio, 0.96; 95% CI, 0.92 to 0.99) to be independent determinants of survival. Conclusion: Both severity of illness and high PEEP settings are associated with the decreased survival of patients with ILD who are receiving mechanical ventilation.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1113-1119 |
| Number of pages | 7 |
| Journal | Chest |
| Volume | 133 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 2008 |
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Keywords
- Artificial respiration
- ICU
- Interstitial lung disease
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
Cite this
Ventilator settings and outcome of respiratory failure in chronic interstitial lung disease. / Fernández-Pérez, Evans R.; Yilmaz, Murat; Jenad, Hussam; Daniels, Craig E.; Ryu, Jay H; Hubmayr, Rolf D.; Gajic, Ognjen.
In: Chest, Vol. 133, No. 5, 05.2008, p. 1113-1119.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Ventilator settings and outcome of respiratory failure in chronic interstitial lung disease
AU - Fernández-Pérez, Evans R.
AU - Yilmaz, Murat
AU - Jenad, Hussam
AU - Daniels, Craig E.
AU - Ryu, Jay H
AU - Hubmayr, Rolf D.
AU - Gajic, Ognjen
PY - 2008/5
Y1 - 2008/5
N2 - Background: While patients with interstitial lung disease (ILD) may be particularly susceptible to ventilator-induced lung injury, ventilator strategies have not been studied in this group of patients. Purpose: To describe the clinical course and outcome of patients with ILD and acute respiratory failure in relation to ventilatory parameters. Methods: We retrospectively identified a cohort of ventilated patients with ILD who had been admitted to five ICUs at a single institution. We analyzed demographic data, pulmonary function test results, severity of illness, and the parameters of continuous ventilation for the initial 24 h after admission to the ICU. Primary outcomes were survival to hospital discharge and 1-year survival. Main results: Of 94 patients with ILD, 44 (47%) survived to hospital discharge and 39 (41%) were alive at 1 year. Nonsurvivors 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 (PEEP) of > 10 cm H2O were attempted in 20 patients and resulted in an increase in plateau pressure (median difference, + 16 cm H2O; interquartile range [IQR], 9 to 24 cm H2O) and a decrease in respiratory system compliance (median difference, -0.28 mL/kg/cm H2O; IQR, - 0.43 to - 0.13 mL/kg/cm H2O). The Cox proportional hazards model revealed that high PEEP (hazard ratio, 4.72; 95% confidence interval [CI], 2.06 to 11.15), acute physiology and chronic health evaluation (APACHE) III score predicted mortality (hazard ratio 1.33; 95% CI, 1.18 to 1.50), age (hazard ratio, 1.03; 95% CI, 1 to 1.05), and low PaO2/fraction of inspired oxygen ratio (hazard ratio, 0.96; 95% CI, 0.92 to 0.99) to be independent determinants of survival. Conclusion: Both severity of illness and high PEEP settings are associated with the decreased survival of patients with ILD who are receiving mechanical ventilation.
AB - Background: While patients with interstitial lung disease (ILD) may be particularly susceptible to ventilator-induced lung injury, ventilator strategies have not been studied in this group of patients. Purpose: To describe the clinical course and outcome of patients with ILD and acute respiratory failure in relation to ventilatory parameters. Methods: We retrospectively identified a cohort of ventilated patients with ILD who had been admitted to five ICUs at a single institution. We analyzed demographic data, pulmonary function test results, severity of illness, and the parameters of continuous ventilation for the initial 24 h after admission to the ICU. Primary outcomes were survival to hospital discharge and 1-year survival. Main results: Of 94 patients with ILD, 44 (47%) survived to hospital discharge and 39 (41%) were alive at 1 year. Nonsurvivors 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 (PEEP) of > 10 cm H2O were attempted in 20 patients and resulted in an increase in plateau pressure (median difference, + 16 cm H2O; interquartile range [IQR], 9 to 24 cm H2O) and a decrease in respiratory system compliance (median difference, -0.28 mL/kg/cm H2O; IQR, - 0.43 to - 0.13 mL/kg/cm H2O). The Cox proportional hazards model revealed that high PEEP (hazard ratio, 4.72; 95% confidence interval [CI], 2.06 to 11.15), acute physiology and chronic health evaluation (APACHE) III score predicted mortality (hazard ratio 1.33; 95% CI, 1.18 to 1.50), age (hazard ratio, 1.03; 95% CI, 1 to 1.05), and low PaO2/fraction of inspired oxygen ratio (hazard ratio, 0.96; 95% CI, 0.92 to 0.99) to be independent determinants of survival. Conclusion: Both severity of illness and high PEEP settings are associated with the decreased survival of patients with ILD who are receiving mechanical ventilation.
KW - Artificial respiration
KW - ICU
KW - Interstitial lung disease
UR - http://www.scopus.com/inward/record.url?scp=43649087623&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=43649087623&partnerID=8YFLogxK
U2 - 10.1378/chest.07-1481
DO - 10.1378/chest.07-1481
M3 - Article
C2 - 17989156
AN - SCOPUS:43649087623
VL - 133
SP - 1113
EP - 1119
JO - Chest
JF - Chest
SN - 0012-3692
IS - 5
ER -