High Flow Oxygen Therapy and Short-term Mortality in IPF Patients With Respiratory Failure

Jun 21, 2019

The findings of the study, “High-flow nasal cannula oxygen therapy to treat acute respiratory failure in patients with acute exacerbation of idiopathic pulmonary fibrosis,” were published in the journal Therapeutic Advances in Respiratory Disease.

Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease of unknown origin that leads to the formation of scar tissue in the lungs, making it hard for patients to breathe. During the disease’s course, many patients experience acute exacerbations (AEs) that in turn may lead to acute respiratory failure (ARF). ARF is a medical condition in which blood contains high levels of carbon dioxide, and low levels of oxygen, due to poor lung function.

“In the absence of proven beneficial therapies, clinicians may decide to prescribe supportive treatment to patients with AE-IPF who develop ARF in the attempt to normalize their ventilation and oxygenation and thus to improve their clinical outcomes,” the investigators said.

“But, despite conventional oxygen therapy and invasive or non-invasive ventilatory assistance, it is difficult to correct blood gas abnormalities; patient outcomes frequently remain poor with the majority dying within the first month and most of the remaining ones, within one year,” they added.

Some strategies have recently been proposed to overcome the lack of blood oxygenation in adults undergoing ARF. One such strategy is high-flow nasal cannula (HFNC) oxygen therapy, a technique in which patients breathe in a heated, humidified gas mixture containing the exact amount of inspired oxygen.

To learn more, researchers from the University of Padova, in Italy, and their collaborators, set out to assess whether incorporating a treatment algorithm based on HFNC oxygen therapy might reduce the short-term mortality of people with AE-IPF who develop ARF.

The observational, retrospective, cohort study was based on medical records from 17 AE-IPF patients, with a median age of 67 years, who developed ARF. All were admitted to the respiratory intensive care unit (RICU) of the University of Padova Medical Center between May 2013 and April 2018.

The patients were treated with a therapy algorithm based on HFNC. Short-term mortality rates —mortality rates during the individuals’ stay at the RICU — were used as an outcome measure.

Results showed the use of the new treatment algorithm was associated with a positive outcome in nine (52.9%) patients. It was tied to a negative outcome in eight (47.1%) patients, who passed away within 39 days after being admitted to the RICU.

The main causes of death were multiorgan failure with acute renal failure (six patients), with one patient dying from septic shock, and one from cardiac arrest.

The patients’ survival rate dropped gradually from 70.6% at 15 days after being admitted to RICU, to 15.6% after one year of being admitted to the care unit.

The study found that four out of 10 patients who failed to respond to conventional oxygen therapy had a satisfactory response to HFNC. They were discharged from the RICU.

Overall, “short-term mortality fell to below 50% when a treatment algorithm incorporating HFNC was implemented in a group of patients with AE-IPF admitted to a RICU for ARF,” the researchers concluded, emphasizing that “patients not responding to conventional oxygen therapy seemed to benefit from HFNC.”

“[A]lthough the treatment algorithm incorporating HFNC needs to be verified in a larger number of cases, the data outlined here provide encouraging results as far [as] the short-term mortality of patients with AE-IPF in an intensive care unit setting is concerned,” the team added.

Adapted from pulmonaryfibrosisnews.com