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

Evans R. Fernández-Pérez, Murat Yilmaz, Hussam Jenad, Craig E. Daniels, Jay H Ryu, Rolf D. Hubmayr, Ognjen Gajic

Research output: Contribution to journalArticle

64 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)1113-1119
Number of pages7
JournalChest
Volume133
Issue number5
DOIs
StatePublished - May 2008

Fingerprint

Interstitial Lung Diseases
Mechanical Ventilators
Respiratory Insufficiency
Positive-Pressure Respiration
Confidence Intervals
Survival
Ventilator-Induced Lung Injury
Pressure
APACHE
Respiratory Function Tests
Tidal Volume
Artificial Respiration
Proportional Hazards Models
Respiratory System
Compliance
Ventilation
Demography
Oxygen
Mortality

Keywords

  • Artificial respiration
  • ICU
  • Interstitial lung disease

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Fernández-Pérez, E. R., Yilmaz, M., Jenad, H., Daniels, C. E., Ryu, J. H., Hubmayr, R. D., & Gajic, O. (2008). Ventilator settings and outcome of respiratory failure in chronic interstitial lung disease. Chest, 133(5), 1113-1119. https://doi.org/10.1378/chest.07-1481

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 journalArticle

Fernández-Pérez, ER, Yilmaz, M, Jenad, H, Daniels, CE, Ryu, JH, Hubmayr, RD & Gajic, O 2008, 'Ventilator settings and outcome of respiratory failure in chronic interstitial lung disease', Chest, vol. 133, no. 5, pp. 1113-1119. https://doi.org/10.1378/chest.07-1481
Fernández-Pérez ER, Yilmaz M, Jenad H, Daniels CE, Ryu JH, Hubmayr RD et al. Ventilator settings and outcome of respiratory failure in chronic interstitial lung disease. Chest. 2008 May;133(5):1113-1119. https://doi.org/10.1378/chest.07-1481
Fernández-Pérez, Evans R. ; Yilmaz, Murat ; Jenad, Hussam ; Daniels, Craig E. ; Ryu, Jay H ; Hubmayr, Rolf D. ; Gajic, Ognjen. / Ventilator settings and outcome of respiratory failure in chronic interstitial lung disease. In: Chest. 2008 ; Vol. 133, No. 5. pp. 1113-1119.
@article{c187c137b4fa45a5bef0fa756b71dab8,
title = "Ventilator settings and outcome of respiratory failure in chronic interstitial lung disease",
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.",
keywords = "Artificial respiration, ICU, Interstitial lung disease",
author = "Fern{\'a}ndez-P{\'e}rez, {Evans R.} and Murat Yilmaz and Hussam Jenad and Daniels, {Craig E.} and Ryu, {Jay H} and Hubmayr, {Rolf D.} and Ognjen Gajic",
year = "2008",
month = "5",
doi = "10.1378/chest.07-1481",
language = "English (US)",
volume = "133",
pages = "1113--1119",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "5",

}

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 -