The effect of mechanical ventilation to acute exacerbation of IPF and CTD-ILD

Background: The mechanism of acute exacerbation of ILD has not been elucidated thoroughly, and no effective therapy in clinic has yet been developed. Patients often need to be hospitalized in RICU with mechanical ventilation (MV) treatment. A retrospective cohort study was designed to assess the efficacy on patients with acute exacerbation of idiopathic pulmonary fibrosis (IPF)and connective tissue disease-ILD(CTD-ILD) treated with MV in RICU. Methods: A retrospective analysis was made on the clinical data of patients in RICU who suffered from acute exacerbation of IPF or CTD-ILD in three teaching hospitals in Beijing during Jan 1st, 2011 to Dec 31st, 2015. The patients were divided into two groups according to diseases, and their epidemiological characteristics, MV mode parameters and prognosis were compared. Results: The cohort consisted of 58 patients (37 males and 21 females) with a median age of 70 (61~78). Age, gender, APACHⅡscore, oxygenation index, number of noninvasive/invasive MV mode, duration of noninvasive/invasive MV time and hospitalization time between two groups had no significant statistical difference. However, in-hospital mortality rates of the groups of acute exacerbation of IPF and CTD-ILD in RICU were 97% and 76% respectively, and there was a statistically significant difference between the two groups (X2 =5.894，P=0.035). Conclusions The therapeutic efficacy of MV on acute exacerbation of IPF and CTD-ILD varied significantly. The morality rate of AE-IPF was extremely high while the acute exacerbation of CTD-ILD has relatively moderate outcome. Invasive MV did not improve the survival rate in both groups. We advise no invasive MV treatment should be utilized to both groups in RICU.