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Prognosis of Patients With Advanced Idiopathic Pulmonary Fibrosis Requiring Mechanical Ventilation for Acute Respiratory Failure: Result2

Prognosis of Patients With Advanced Idiopathic Pulmonary Fibrosis Requiring Mechanical Ventilation for Acute Respiratory Failure: Result2At admission to ICU, the adODIN score was 1.40 ± 0.6. Seven patients had an adODIN score > 1. In addition to respiratory failure that was present in all patients, cardiovascular dysfunction was observed in two patients and documented infection was found in five patients (two of whom had also cardiovascular dysfunction). Eleven patients (48%) developed at least one organ dysfunction and/or infection after the initiation of MV. The endODIN (2.45 ± 0.9) was significantly higher than the iniO-DIN (1.86 ± 1.0; p = 0.005). Cardiovascular failure (five patients), renal failure (three patients), and a combination of cardiovascular and renal failure (two patients) were the most common organ dysfunctions developing after initiation of MV. Nosocomial pneumonia occurred in four other patients. No significant difference was found between the number of organ dysfunctions in the 10 patients who died within 2 days (2.4 ± 0.96) and that of patients who died after day 2 (2.4 ± 0.95; p = 0.94). Moreover, no correlation was found between the number of organ failures and the duration of MV (R = — 0.11, p = 0.6).
In the 10 patients who died within the first 2 days after intubation, the cause of death was oxygenation failure and severe alveolar hypoventilation associated with hemodynamic failure in 8 patients. The other causes of death were brain death related to severe hypoxemia (n = 1) and septic shock associated with left ventricular failure (n = 1). In these 10 patients, the mean Pa02/Fl02 ratio, the mean PaC02, and the mean peak airway pressure within the 24 h before death were 81 ± 56 mm Hg, 90 ± 46 mm Hg, and 60.5 ± 20 cm H2O, respectively. In the 12 patients who died after day 2, causes of death were as follows: oxygenation failure and severe alveolar hypoventilation (n = 3); oxygenation failure and severe alveolar hypoventilation associated with hemodynamic failure (n = 5), with acute renal failure (n = 1) or with bacterial pneumonia (n = 1); hemodynamic failure (n = 1); and acute intestinal obstruction (n = 1).
Blood gas and right-sided hemodynamic measurements were obtained in four patients who received inhaled nitric oxide. Despite this treatment, no significant change in hemodynamic or oxygenation parameters was observed. Nine patients received high-dose corticosteroids (15 mg/kg) after initiation of MV without visible effect on arterial oxygenation.