S101 Intensive Care Unit Admission Should Play a Role in the Management of Selected Patients with Interstitial Lung Disease
Introduction and Objectives Little is known about outcomes of patients with interstitial lung disease (ILD) requiring emergency admission to the intensive care unit (ICU). Historically, based on data for patients with idiopathic pulmonary fibrosis (IPF), in whom outcome is poor, there has been a reluctance to provide advanced support for individuals with ILD. The aim of this study was to evaluate outcomes of patients with ILD admitted to ICU.
Methods A retrospective review of electronic patient records, ICU database and clinical notes was undertaken for all patients with confirmed ILD admitted to ICU between January 2006 and June 2012 in a single tertiary ILD referral centre. Patients admitted electively for bronchoscopy in a high-dependency environment (n=10, no complications) were not included.
Results We identified 35 patients (21 male), mean age 48 (range 18–76) years. Of these, 20 were inpatients referred by the ILD team at the same hospital, 6 were admitted following deterioration after a thoracic surgical procedure and 9 were directly transferred from other hospital ICUs.
The most common diagnoses were connective tissue disease -associated ILD (6), pulmonary alveolar proteinosis, PAP (4), sarcoidosis (4), IPF (4) and hypersensitivity pneumonitis (3).
Twenty-seven (77%) patients received invasive mechanical ventilation, 4 of whom also required extracorporeal support for gas exchange. The majority of patients received immunosuppressive therapy with corticosteroids, and over one-third received cyclophosphamide and/or rituximab whilst in ICU.
Overall, 21 (60%) survived to ICU discharge, only 1 of whom died before hospital discharge. Sixteen (47%) patients survived to 6 months. All 4 patients with IPF died before hospital discharge. All patients with PAP survived to 6 months. ICU length of stay for survivors was 27 (range 1–127) days and for non-survivors was 17 (1–48) days.
Conclusions Our series suggests that aggressive supportive and disease-targeted management of selected patients with ILD is appropriate, and such patients should therefore be considered for transfer to a specialist unit.