Sehgal Inderpaul Singh, Agarwal Ritesh, Dhooria Sahajal, Prasad Kuruswamy Thurai, Aggarwal Ashutosh N, Behera Digambar
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Sarcoidosis Vasc Diffuse Lung Dis. 2018;35(4):363-370. doi: 10.36141/svdld.v35i4.7066. Epub 2020 Mar 9.
Acute respiratory failure (ARF) due to diffuse parenchymal lung diseases (DPLDs) is associated with high mortality. Whether ARF due to acute interstitial pneumonia (AIP), idiopathic pulmonary fibrosis (IPF) and non-IPF DPLDs behaves differently remains unclear. A retrospective analysis of consecutive DPLD subjects with ARF admitted to respiratory intensive care unit (RICU). The baseline clinical, demographic characteristics, cause of ARF and mortality were compared between the groups. 145 (5.8% of RICU admission) subjects (mean [SD] age, 51.6 [14.7] years, 406% males) with DPLD-related ARF (17 AIP; 32 IPF; 96 non-IPF DPLD) were admitted. Common causes of ARF were acute exacerbation of the underlying DPLD (n=59, 40.4%) followed by infections (n=48, 37.5%). There was no difference in the peak, plateau and driving pressures across groups. The mortality rate was 45.5% (66/145) and was highest in AIP (82%) followed by IPF (59%) and non-IPF DPLD (34%). On multivariate logistic regression analysis, baseline APACHE II score, PaO:FiO ratio, delta SOFA, and the use of invasive mechanical ventilation were independent predictors of mortality. The type of underlying DPLD however, did not affect survival. DPLD-related ARF is an uncommon cause of admission even in a RICU, and is associated with a high mortality. .
由弥漫性实质性肺疾病（DPLD）导致的急性呼吸衰竭（ARF）与高死亡率相关。因急性间质性肺炎（AIP）、特发性肺纤维化（IPF）和非IPF DPLD导致的ARF表现是否不同仍不清楚。对入住呼吸重症监护病房（RICU）的连续的患有ARF的DPLD患者进行回顾性分析。比较了各组之间的基线临床、人口统计学特征、ARF病因和死亡率。145名（占RICU入院人数的5.8%）患有DPLD相关ARF的患者（平均[标准差]年龄为51.6[14.7]岁，男性占40.6%）入院（17例AIP；32例IPF；96例非IPF DPLD）。ARF的常见病因是潜在DPLD的急性加重（n = 59，40.4%），其次是感染（n = 48，37.5%）。各组之间的峰压、平台压和驱动压没有差异。死亡率为45.5%（66/145），在AIP组中最高（82%），其次是IPF组（59%）和非IPF DPLD组（34%）。多因素逻辑回归分析显示，基线急性生理与慢性健康状况评分系统II（APACHE II）评分、动脉血氧分压与吸入氧浓度比值（PaO:FiO）、序贯器官衰竭评估（SOFA）评分变化值（delta SOFA）以及有创机械通气的使用是死亡率的独立预测因素。然而，潜在DPLD的类型并不影响生存率。即使在RICU，DPLD相关ARF也是一种不常见的入院原因，且与高死亡率相关。
