Matsunashi Atsushi, Nagata Kazuma, Morimoto Takeshi, Tomii Keisuke
Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan.
Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan.
Respir Investig. 2023 May;61(3):306-313. doi: 10.1016/j.resinv.2023.01.008. Epub 2023 Mar 1.
Acute exacerbation of fibrosing interstitial lung diseases, including idiopathic pulmonary fibrosis, is associated with poor prognosis. Accordingly, tracheal intubation and invasive mechanical ventilation are generally avoided in such patients. However, the efficacy of invasive mechanical ventilation for acute exacerbation of fibrosing interstitial lung diseases remains unclear. Therefore, we aimed to investigate the clinical course of patients with acute exacerbation of fibrosing interstitial lung diseases who were treated with invasive mechanical ventilation.
We retrospectively analyzed 28 patients with acute exacerbation of fibrosing interstitial lung diseases who underwent invasive mechanical ventilation at our hospital.
Of the 28 included patients (20 men, 8 women; mean age, 70.6 years), 13 (46.4%) were discharged alive and 15 died. Ten patients (35.7%) had idiopathic pulmonary fibrosis. Univariate analysis revealed that longer survival was significantly associated with lower partial pressure of arterial carbon dioxide (hazard ratio [HR] 1.04 [1.01-1.07]; p = 0.002) and higher pH (HR 0.0002 [0-0.02] levels; p = 0.0003) and less severe general status according to the Acute Physiology and Chronic Health Evaluation II score (HR 1.13 [1.03-1.22]; p = 0.006) at the time of mechanical ventilation initiation. In addition, the univariate analysis indicated that patients without long-term oxygen therapy use had significantly longer survival (HR 4.35 [1.51-12.52]; p = 0.006).
Invasive mechanical ventilation may effectively treat acute exacerbation of fibrosing interstitial lung diseases if good ventilation and general conditions can be maintained.
包括特发性肺纤维化在内的纤维化间质性肺疾病急性加重与预后不良相关。因此，这类患者通常避免气管插管和有创机械通气。然而，有创机械通气治疗纤维化间质性肺疾病急性加重的疗效仍不明确。因此，我们旨在研究接受有创机械通气治疗的纤维化间质性肺疾病急性加重患者的临床病程。
我们回顾性分析了我院28例接受有创机械通气治疗的纤维化间质性肺疾病急性加重患者。
28例纳入患者中（20例男性，8例女性；平均年龄70.6岁），13例（46.4%）存活出院，15例死亡。10例患者（35.7%）患有特发性肺纤维化。单因素分析显示，较长的生存期与较低的动脉血二氧化碳分压显著相关（风险比[HR]1.04[1.01 - 1.07]；p = 0.002）、较高的pH值（HR 0.0002[0 - 0.02]水平；p = 0.0003）以及机械通气开始时根据急性生理与慢性健康状况评估II评分得出的较轻全身状况（HR 1.13[1.03 - 1.22]；p = 0.006）有关。此外，单因素分析表明，未长期使用氧疗的患者生存期显著更长（HR 4.35[1.51 - 12.52]；p = 0.006）。
如果能够维持良好的通气和全身状况，有创机械通气可能有效治疗纤维化间质性肺疾病急性加重。
