Dhanani Zehra, Gupta Rohit
Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA 19140, USA.
Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA.
J Clin Med. 2024 Nov 6;13(22):6657. doi: 10.3390/jcm13226657.
Interstitial lung disease (ILD) encompasses a diverse group of parenchymal lung diseases characterized by varying degrees of inflammation and/or fibrosis. Patients with ILD frequently require hospitalization, with many needing intensive care unit (ICU) admission, most often due to respiratory failure. The diagnosis and management of ILD in the ICU present unique challenges. Diagnosis primarily relies on chest CT imaging to identify fibrosis and inflammation. Acute exacerbations, whether in idiopathic pulmonary fibrosis (IPF) or non-IPF ILD, require careful evaluation of potential triggers and differential diagnoses. Bronchoalveolar lavage may provide valuable information, such as the identification of infections, but carries risks of complications. Biopsies, whether transbronchial or surgical, can also be informative but pose significant procedural risks. Corticosteroids are the cornerstone of treatment for acute exacerbations of IPF, with higher doses potentially benefiting non-IPF ILD. Additional immunosuppressive agents may be used in cases with evidence of inflammation. Oxygen supplementation, particularly with high-flow nasal cannula, is often employed to manage severe hypoxemia, while noninvasive ventilation can be useful for worsening hypoxemia and/or hypercapnia. When mechanical ventilation is used, it is recommended to target low tidal volumes to minimize lung injury; high PEEP may be less effective and even associated with increased mortality. Prone positioning can improve oxygenation in severely hypoxemic patients. In addition to ventilatory strategies, careful fluid management and addressing concomitant pulmonary hypertension are essential components of care. Extracorporeal membrane oxygenation is a high-risk intervention reserved for the most severe cases. Lung transplantation may be considered for end-stage ILD patients in the ICU, with outcomes dependent on the urgency of transplantation and the patient's overall condition. Managing ILD in the ICU requires a multidisciplinary approach, and despite recent advances, mortality remains high, emphasizing the need for continued research and individualized treatment strategies.
间质性肺疾病（ILD）涵盖了多种实质性肺疾病，其特征为不同程度的炎症和/或纤维化。ILD患者经常需要住院治疗，许多患者需要入住重症监护病房（ICU），最常见的原因是呼吸衰竭。在ICU中对ILD进行诊断和管理面临着独特的挑战。诊断主要依靠胸部CT成像来识别纤维化和炎症。急性加重期，无论是特发性肺纤维化（IPF）还是非IPF-ILD，都需要仔细评估潜在的触发因素并进行鉴别诊断。支气管肺泡灌洗可能会提供有价值的信息，如识别感染，但存在并发症风险。活检，无论是经支气管活检还是外科活检，也可能提供信息，但存在重大的操作风险。皮质类固醇是IPF急性加重期治疗的基石，较高剂量可能对非IPF-ILD有益。在有炎症证据的情况下，可能会使用其他免疫抑制剂。补充氧气，特别是使用高流量鼻导管吸氧，常用于治疗严重低氧血症，而无创通气对于低氧血症恶化和/或高碳酸血症可能有用。当使用机械通气时，建议采用低潮气量以尽量减少肺损伤；高呼气末正压（PEEP）可能效果较差，甚至与死亡率增加有关。俯卧位可改善严重低氧血症患者的氧合。除了通气策略外，仔细的液体管理和处理合并的肺动脉高压是护理的重要组成部分。体外膜肺氧合是一种高风险的干预措施，仅用于最严重的病例。对于ICU中的终末期ILD患者，可考虑进行肺移植，其结果取决于移植的紧迫性和患者的整体状况。在ICU中管理ILD需要多学科方法，尽管最近有进展，但死亡率仍然很高，这强调了持续研究和个体化治疗策略的必要性。
