Outcome of Patients With Idiopathic Pulmonary Fibrosis Admitted to the ICU for Respiratory Failure

Study objectives To analyze the outcome of acuterespiratory failure (ARF) in patients with idiopathic pulmonaryfibrosis (IPF), and to evaluate the benefits of invasive andnoninvasive mechanical ventilation (MV). Design Retrospective study. Setting Universityhospital. Patients Fifteen consecutive patients with IPF referred to the ICU for ARF between January 1989 and June1998. Measurements and results Fifteen patients(mean ± SD age, 64 ± 10 years) were included. Eight patients hadclinical, functional, and radiologic features of IPF, and the remainingseven patients also had biopsy specimen-proven IPF. The mean durationbetween diagnosis of IPF and admission to the ICU was 26.5 ± 28months. At the time of ICU admission, mean arterial blood gas levelswere as follows: Pao 2 /fraction of inspiredoxygen, 113 ± 95; pH, 7.32 ± 0.10; and Paco 2 , 55 ± 21 mm Hg. All patients received MV; 12 patients required tracheal intubation, either at the time of ICUadmission (n = 10) or after failure of noninvasive ventilation (NIV;n = 2); and 3 patients only received NIV. Three of the five patientsreceiving NIV died of respiratory failure. Eleven patients died in the ICU, either from hypoxemia (n = 8) or from septic shock (n = 3). Four patients were discharged alive from the ICU, and two of them diedshortly thereafter. Conclusion The outcome ofpatients with IPF referred to the ICU for ARF was very poor and notimproved by MV. Without a clearly identified reversible cause of ARF, these patients should not benefit from admission to the ICU.