Yokoyama Toshiki, Kondoh Yasuhiro, Taniguchi Hiroyuki, Kataoka Kensuke, Kato Keisuke, Nishiyama Osamu, Kimura Tomoki, Hasegawa Ryuichi, Kubo Keishi
The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto.
Intern Med. 2010;49(15):1509-14. doi: 10.2169/internalmedicine.49.3222. Epub 2010 Aug 2.
The outcome of acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is usually very poor, and it has been suggested that mechanical ventilation does not benefit AE-IPF patients. Noninvasive ventilation (NIV) has attracted attention as a means to avoid intubation in acute respiratory failure, including acute respiratory distress syndrome (ARDS). This study describes the outcome of patients with AE-IPF who were treated with NIV.
Patients included in the study were those who fulfilled the criteria for AE-IPF during the periods between April 1998 and June 2004 at Tosei General Hospital, and in whom NIV was introduced. Clinical data were obtained retrospectively from patient records.
This study included 11 patients. The initial NIV settings were continuous positive airway pressure (CPAP) mode in 6 patients (mean 10.1+/-2.5 cmH(2)O) and Spontaneous/Timed mode in 5 (mean inspiratory positive airway pressure/expiratory positive airway pressure; 15.0+/-3.3/10.2+/-2.9 cmH(2)O). Five patients avoided intubation and survived more than 3 months after AE-IPF. Six patients who failed NIV died within 3 months. In these 6 patients, 4 required intubation. The other 2 patients, who refused endotracheal intubation, died without intubation. Median survival time and 3-month survivals after acute exacerbation were 30 days, and 45.5%, respectively.
Considering extremely poor prognosis of AE-IPF, our findings suggest that NIV is a viable option for the respiratory management in AE-IPF, and should be studied in a large, well-controlled trial.
特发性肺纤维化急性加重（AE - IPF）的预后通常很差，有人认为机械通气对AE - IPF患者并无益处。无创通气（NIV）作为避免急性呼吸衰竭（包括急性呼吸窘迫综合征（ARDS））患者插管的一种手段已受到关注。本研究描述了接受NIV治疗的AE - IPF患者的预后情况。
纳入研究的患者为1998年4月至2004年6月期间在东海综合医院符合AE - IPF标准且接受NIV治疗的患者。临床数据通过回顾患者病历获得。
本研究纳入11例患者。初始NIV设置中，6例采用持续气道正压通气（CPAP）模式（平均10.1±2.5 cmH₂O），5例采用自主/定时模式（平均吸气气道正压/呼气气道正压；15.0±3.3/10.2±2.9 cmH₂O）。5例患者避免了插管，并在AE - IPF发作后存活超过3个月。6例NIV治疗失败的患者在3个月内死亡。在这6例患者中，4例需要插管。另外2例拒绝气管插管的患者未插管死亡。急性加重后的中位生存时间和3个月生存率分别为30天和45.5%。
考虑到AE - IPF预后极差，我们的研究结果表明NIV是AE - IPF呼吸管理的一种可行选择，应在大规模、严格对照的试验中进行研究。
