Constantino Krishna, Gottlieb Michael, Long Brit
Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas.
Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois.
J Emerg Med. 2023 Feb;64(2):156-166. doi: 10.1016/j.jemermed.2022.10.015. Epub 2023 Jan 25.
Interstitial lung disease (ILD) is a group of restrictive pulmonary diseases associated with diffuse interstitial and parenchymal inflammation. Patients can present to the emergency department with severe exacerbation.
This narrative review provides emergency clinicians with the most recent evidence concerning acute exacerbation of ILD (AE-ILD).
AE-ILD can present as acute respiratory distress in a patient with a pre-existing ILD diagnosis or as a de novo presentation of ILD, and is associated with significant morbidity and mortality. A variety of underlying triggers may result in AE-ILD. Emergency clinicians must first assess for extraneous causes of respiratory decompensation prior to diagnosing AE-ILD. For a de novo presentation of ILD, emergency physicians should also assess for possible reversible causes. AE-ILD is managed with systemic steroids, immunosuppressants, intravenous antibiotics, supplemental oxygen, and extracorporeal membrane oxygenation in severe cases. Given the high mortality rates in the absence of lung transplantation, early referral to transplant centers is essential to increase chances of survival.
Emergency clinician knowledge of AE-ILD can improve the evaluation and management of these patients.
间质性肺疾病（ILD）是一组与弥漫性间质和实质炎症相关的限制性肺部疾病。患者可能因病情严重加重而就诊于急诊科。
本叙述性综述为急诊临床医生提供有关ILD急性加重（AE-ILD）的最新证据。
AE-ILD可表现为已有ILD诊断患者的急性呼吸窘迫，或作为ILD的新发表现，且与显著的发病率和死亡率相关。多种潜在诱因可能导致AE-ILD。急诊临床医生在诊断AE-ILD之前必须首先评估呼吸代偿失调的外在原因。对于ILD的新发表现，急诊医生还应评估可能的可逆原因。AE-ILD采用全身用类固醇、免疫抑制剂、静脉用抗生素、补充氧气治疗，严重病例采用体外膜肺氧合治疗。鉴于在没有肺移植的情况下死亡率很高，早期转诊至移植中心对于提高生存机会至关重要。
急诊临床医生对AE-ILD的了解可改善这些患者的评估和管理。
