Mechanical Ventilation Strategy in Pulmonary Fibrosis with Severe Respiratory Failure

  Objective  To study the strategy of mechanical ventilation in pulmonary fibrosis with severe respiratory failure.

  Methods  Fifty-four pulmonary fibrosis patients with severe respiratory failure requiring ventilatory support were divided into noninvasive ventilation group (n=21) and invasive ventilation group (n=33). The patients in noninvasive ventilation group were treated with noninvasive bi-level positive airway pressure (BiPAP) ventilation, and the patients in invasive ventilation group underwent endotracheal intubation and mechanical ventilation. Arterial blood gas was detected before ventilation and after one hour of ventilatory support. The complications of mechanical ventilation, mortality rate, and length of hospital stay were recorded.

  Results  Significant improvements in PaO₂ after one hour of ventilatory support were noted in both groups(P < 0.01). The incidence rate of complications in noninvasive ventilation group was lower than that in invasive ventilation group (23.8% versus 51.5%, P=0.043). No significant difference was found in the mortality rate between these two groups (90.5% versus 93.9%, P=0.636). The hospital stay of noninvasive ventilation group was significantly shorter than that of invasive ventilation group (13.1±11.7 days versus 19.4±15.8 days, P=0.008).

  Conclusions  Neither noninvasive ventilation nor invasive mechanical ventilation can remarkably improve the survival of pulmonary fibrosis patients with severe respiratory failure. However, noninvasive ventilation can be applied in selected patients due to its lower incidence of complication and shorter hospital stay.