The death rate of pulmonary fibrosis patients who were put on a hospital ventilator was seven times higher than those treated without a ventilator, according to a review of thousands of medical records.
The study of 22,350 admissions also showed that the cost of treating patients who were put on a ventilator was four times higher than for those treated without a ventilator. The study applied only to patients who had not had a lung transplant. A ventilator is a device that helps a person with idiopathic pulmonary fibrosis (IPF) breathe in and out.
The study, funded by Genentech, was titled “Mechanical ventilation in idiopathic pulmonary fibrosis: a nationwide analysis of ventilator use, outcomes, and resource burden.” It was published in the journal BMC Pulmonary Medicine.
IPF involves the scarring of lung tissue for reasons scientists have yet to discover. It leads to poor patient outcomes.
Guidelines for treating IPF recommend against ventilator use among patients who are not waiting for a lung transplant. The guidelines were based on previous studies, and the results of the Genentech-sponsored research confirmed the conclusion.
The researchers looked at records in the Nationwide Inpatient Sample (NIS), a database of hospital stays covered by Medicare, Medicaid and private insurance, and that included uninsured people. The team identified 22,350 IPF patients admitted to a hospital for respiratory problems between 2009-2011.
They found that 1,995 or 8.9% of the patients were put on a ventilator. Sixty percent were men, and their average age was 65.9 years, versus 70.5 for those who did not go on a ventilator.
Ventilator users’ average stay was 9.78 days longer than non-users, and the cost of their stay was $36,583 higher than non-users’.
A stark finding was that 55.7% of ventilator users died, compared with 7.5% of non-users.
The team dispelled the notion that some of the ventilator-user deaths could have been from other conditions, such as a cardiovascular disease or pneumonia, by saying that the deaths appeared to be associated with IPF.
“IPF treatment guidelines recommend the majority of IPF patients with respiratory failure not receive MV [mechanical ventilator treatment], and when used, should occur after assessing patient-specific goals of care or lung transplant candidacy,” the researchers wrote.
“Mechanical ventilation use has not significantly changed over time, and is mostly used in younger patients and those admitted for non-IPF respiratory conditions,” the team wrote. “MV was associated with a four-fold [hospital] admission cost increase ($49,924 versus $11,742) and a seven-fold mortality increase (56% versus 7.5%), although patients who receive MV may differ from those who do not.
“Advances in treatment and decision aids are needed to improve outcomes in IPF,” the researchers concluded.