A new treatment algorithm for acute exacerbation of IPF: a retrospective cohort study

Background: Some patients with Idiopathic Pulmonary Fibrosis (IPF) develop acute exacerbation (AE-IPF) leading to severe Acute Respiratory Failure (ARF); despite conventional supportive therapy, the mortality rate remains extremely high. Aims and Objectives: To assess how a treatment algorithm incorporating High Flow Nasal Cannula (HNFC) oxygen therapy and Extracorporeal CO2 Removal (ECCO2R) may affect the short-term mortality of patients with AE-IPF who develop ARF. Methods: Seventeen AE-IPF patients admitted to a Respiratory Intensive Care Unit (RICU) for ARF were managed using a treatment algorithm incorporating HFNC and ECCO2R. Mortality rate during their stay in the RICU and short-term survival rates were recorded. Results: The implementation of the treatment algorithm led to a successful outcome in 9 patients (52.9%). 8 patients (47.1%) died within 39 days of being admitted to the RICU. The survival rate was 70.6% (±0.1 %) at 15 days, 52.9% (±0.1%) at 30 days, 35.3% (±0.1%) at 90 days, and 15.6% (±9.73 %) at 365 days. Four/10 patients who did not respond to conventional oxygen therapy showed a satisfactory response to HFNC. Conclusions: Short-term mortality fell to below 50 per cent when a treatment algorithm incorporating HFNC and ECCO2R was implemented in a group of AE-IPF patients admitted to a RICU for ARF. Subjects not responding to conventional oxygen therapy seemed to benefit from HFNC.