Role of non-invasive ventilation in managing life-threatening acute exacerbation of interstitial pneumonia

Abstract

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 AEIP 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 PaO2/FiO2 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. © 2010 The Japanese Society of Internal Medicine.