Study Links IPF Mortality to Mechanical Ventilation After High-flow Nasal Cannula Oxygen Therapy
Mechanical ventilation is associated with higher mortality rates in hospitalized patients with idiopathic pulmonary fibrosis (IPF) and acute respiratory failure who previously received high-flow nasal cannula oxygen therapy, study says.
Future studies are needed to establish strategies for patients to safely transition from oxygen therapy to mechanical ventilation, the researchers noted.
The study, “High-flow nasal cannula oxygen therapy in idiopathic pulmonary fibrosis patients with respiratory failure,” was published in the Journal of Thoracic Disease.
IPF prognosis is usually poor, particularly for those also developing acute respiratory failure (ARF) — a condition in which the levels of carbon dioxide in the blood increase and the levels of oxygen decrease due to poor lung function.
High-flow nasal cannula (HFNC) oxygen therapy, a technique in which patients breathe in a heated, humidified gas mixture containing oxygen, is a form of therapy widely used in IPF patients to overcome the lack of blood oxygenation associated with ARF.
“Although the technique does not reduce the need for endotracheal intubation or mortality compared to conventional oxygen therapy or non-invasive ventilation (NIV), it has advantages such as patient comfort and tolerability,” the researchers wrote.
However, the possible advantages of HFNC oxygen therapy over mechanical ventilation remain unclear for IPF patients with ARF.
Investigators at the University of Ulsan and Dongsuwon General Hospital, in Korea, carried out a retrospective study to compare the clinical outcomes of IPF patients who had been hospitalized due to ARF and received HFNC oxygen therapy or mechanical ventilation.
The main goal of the study was to compare the in-hospital mortality rates seen in patients who received only HFNC oxygen therapy, HFNC oxygen therapy followed by mechanical ventilation, or mechanical ventilation alone, during their hospital stay.
A total of 61 IPF patients with ARF — 48 men and 13 women, with a mean age of 70.8 years — who were admitted to the Asan Medical Center in Seoul, Korea, from January 2015 to December 2017, were included in the study.
From the 61 patients, 45 received only HFNC oxygen therapy during their stay at the hospital, and 16 received mechanical ventilation. From those who received mechanical ventilation, seven had previously received HFNC oxygen therapy, and nine received mechanical ventilation alone.
A total of 36 patients died over the course of the study, yielding an overall in-hospital mortality rate of 59.0%.
Although patients who received HFNC oxygen therapy remained in the hospital (median of 13 versus 24 days) and intensive care unit (median of 0 versus 7 days) for a shorter period of time compared with those who received mechanical ventilation, their mortality rates were similar: 53.3% in the HFNC oxygen therapy group versus 55.6% in the mechanical ventilation group.
“Although no difference in mortality was observed among the three groups, the mortality rate of patients who underwent MV [mechanical ventilation] with prior HFNC oxygen therapy was 100%,” the investigators wrote. “Additionally, the HFNC oxygen therapy group showed shorter length of hospital and [intensive care unit] stay than the MV group.”
Overall, “considering the complication rate of MV, need for lung transplantation, and the will to undergo end-of-life care, a proper transition from HFNC oxygen therapy to MV should be planned cautiously,” the team added.