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Prognosis of Patients With Advanced Idiopathic Pulmonary Fibrosis Requiring Mechanical Ventilation for Acute Respiratory Failure: Assessment of Patients During ARF

Prognosis of Patients With Advanced Idiopathic Pulmonary Fibrosis Requiring Mechanical Ventilation for Acute Respiratory Failure: Assessment of Patients During ARFAssessment of Patients During ARF
Several parameters were retrieved from the medical records: outcome (death or survival), duration of MV up to extubation or death, and percentage of patients who underwent LTx. Arterial blood gas measurements (Radiometer; Copenhagen, Denmark) obtained before initiation of MV and at different time points after MV (within 6 h after initiating the MV [day 0], daily during the first 5 days, and at day 7 and day 10) were also documented. Concerning the oxygenation parameters, the Pao2 value measured before MV regardless of oxygen flow rate was taken. After MV, the Pao2/Flo2 ratio was calculated. The incidence of nosocomial pneumonia in patients receiving MV was also assessed. The diagnosis of nosocomial pneumonia was based on the following criteria: new pulmonary infiltrate on frontal chest radiograph associated with culture of BAL showing > 104 cfu/mL or culture of Wimberley brush catheter demonstrating > 103 cfu/mL and at least one of the following criteria: fever > 38°C, leucocytosis > 10,000/^L, or purulent respiratory secretions.
The presence of organ dysfunction and/or infection in ICU was evaluated using the organ dysfunction and/or infection (ODIN) model described by Fagon and colleagues. This model includes the assessment of respiratory, cardiovascular, renal, hepatic, hematologic, and neurologic dysfunctions, and the presence of documented infection. Each organ failure and/or infection accounts for one point of the score. The highest score over the 24-h period was recorded. ODIN was assessed at ICU admission (adODIN), at the initiation of MV (iniODIN), and at discontinuation of MV (endODIN). In the patients who died, endODIN corresponded to the highest score within the 24 h before death. In the patients who were already receiving MV at ICU admission (n = 4), the adODIN was taken as iniODIN.
Statistical Analysis
All comparisons were unpaired. Statistical analysis was performed using a computer (Sigma Stat; Jandel Scientific; San Jose, CA). Continuous variables were expressed as mean and SDs for normally distributed variables and then compared using a Student’s t test. Nonnormally distributed variables were expressed as median and 25th to 75th percentile values, and then compared using the Mann-Whitney test. For correlation between nonnor-mally distributed variables, the Spearman correlation coefficient was used.
The survival curve was estimated using the Kaplan-Meier method. Multiple comparisons between continuous variables were made using analysis of variance for repeated measures. All p values < 0.05 were considered statistically significant.