Acute exacerbation of interstitial lung disease in the intensive care unit

Abstract

Acute exacerbations of interstitial lung disease (AE-ILD) represent an acute, frequent and often highly morbid event in the disease course of ILD patients. Admission in the intensive care unit (ICU) is very common and the need for mechanical ventilation arises early. While non-invasive ventilation has shown promise in staving off intubation in selected patients, it is unclear whether mechanical ventilation can alter the exacerbation course unless it is a bridge to lung transplantation. Risk stratification using clinical and radiographic findings, and early palliative care involvement, are important in ICU care. In this review, we discuss many of the pathophysiological aspects of AE-ILD and raise the hypothesis that ventilation strategies used in acute respiratory distress syndrome might be implemented in AE-ILD. We present possible decision-making and management algorithms that can be used by the intensivist when caring for these patients.

Keywords: Interstitial lung diseases; Disease exacerbation; Mechanical ventilation; Intensive care unit; Pathophysiological aspect

Core Tip: During the acute and morbid event of acute exacerbation of interstitial lung disease, an intensivist needs to understand the pathophysiology and reversible causes of acute exacerbations, the diagnostics and treatments that are usually recommended, and the experimental therapies on the horizon. More importantly, the intensivist needs to be able to risk stratify the patients, selectively pursue mechanical ventilation, minimize ventilator induced lung injury, and involve palliative care early in non-lung transplant candidates.