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4 &#40;10&#46;8&#37;&#41; chronic hypersensitivity pneumonitis&#59; 3 &#40;8&#46;2&#37;&#41; sarcoidosis&#59; 2 &#40;5&#46;5&#37;&#41; rheumatoid lung &#40;RL&#41;&#59; 2 &#40;5&#46;5&#37;&#41; acute interstitial pneumonitis&#59; 2 &#40;5&#46;5&#37;&#41; unclear ILD&#59; 2 &#40;5&#46;5&#37;&#41; cryptogenic organizing pneumonia &#40;COP&#41;&#59; 1 &#40;2&#46;7&#37;&#41; scleroderma lung and 1 &#40;2&#46;7&#37;&#41; dermatomyositis&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Seventeen had received previous therapy with corticosteroids&#44; 8 immunosuppressant therapy and 10 long term oxygen therapy&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The median length of ICU and hospital stay were 10 days &#40;min&#58; 1&#59; max&#58; 64&#41; and 21 days &#40;min&#58;1&#59; max&#58;100&#41; respectively&#46; Mean APACHE II score was 18&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7 and mean SAPS II was 36&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;5&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Four lung biopsies were performed&#58; 1 surgical lung biopsy and 3 core needle biopsies guided by CT scan&#46; Two of the biopsies were consistent with acute interstitial pneumonitis&#44; 1 with COP and 1 was unclear&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Seventeen &#40;45&#46;9&#37;&#41; patients had acute exacerbation and twenty experienced ARF due to rapid deterioration of disease associated with respiratory infection&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Thirty three patients &#40;89&#46;2&#37;&#41; required IMV&#44; with an median duration of 10 days &#40;min&#58; 1&#59; max&#58; 62&#41;&#46; Nine &#40;24&#46;3&#37;&#41; underwent non-invasive ventilation prior to IMV&#44; 6 required tracheostomy and 3 extracorporeal membrane oxygenation&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Thirty two patients &#40;86&#46;5&#37;&#41; were treated with antibiotics&#44; 21 &#40;56&#46;8&#37;&#41; with corticosteroids&#44; 8 &#40;21&#46;6&#37;&#41; with antifungals&#44; 6 &#40;16&#46;2&#37;&#41; with cyclophosphamid&#44; 6 &#40;16&#46;2&#37;&#41; with antivirals&#44; 2 &#40;5&#46;4&#37;&#41; with plasmapheresis and 1 &#40;2&#46;7&#37;&#41; with rituximab&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Fourteen &#40;37&#46;8&#37;&#41; patients were discharged from the ICU&#58; 4 small vessel vasculitis &#40;ANCA&#43;&#41;&#59; 3 silicosis&#59; 2 sarcoidosis&#59; 2 COP&#59; 1 fibrotic unclassifiable ILD&#59; 1 RL and 1 scleroderma lung&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Twenty three 23 patients &#40;62&#46;2&#37;&#41; died in ICU&#58; IPF &#40;5&#41;&#59; chronic hypersensitivity pneumonitis &#40;4&#41;&#59; fibrotic unclassifiable ILD &#40;4&#41;&#59; silicosis &#40;2&#41;&#59; acute interstitial pneumonitis &#40;2&#41;&#59; unclear ILD &#40;2&#41;&#59; sarcoidosis &#40;1&#41;&#59; small vessel vasculitis &#40;ANCA &#43;&#41; &#40;1&#41;&#59; RL &#40;1&#41;&#59; dermatomyositis &#40;1&#41;&#46; Short term mortality &#40;first month&#41; and overall hospital mortality were 50&#37; &#40;7 patients&#41; and 86&#46;5&#37; &#40;32 patients&#41; respectively&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Four patients did not require IMV&#58; 1 had COP&#44; 1 unclassifiable ILD&#44; 1 small vessel vasculitis &#40;ANCA&#43;&#41; and 1 RL&#46; From this set of patients only the one with small vessel vasculitis &#40;ANCA&#43;&#41; remains alive&#44; the others died in hospital after ICU discharge&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A fibrotic ILD with traction bronchiectasis and honeycombing was associated with a worse outcome &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031&#41;&#44; as well as the need of IMV &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#41;&#46; A worse outcome was not associated with a higher APACHE II score &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;198&#41;&#44; a higher SAPS II score &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;713&#41;&#44; previous oxygen therapy &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;353&#41; or previous immunosuppressant therapy &#40;0&#46;982&#41;&#46; None of the other parameters analyzed were associated with a worse outcome probably due to the small sample size &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">We found a high ICU and short term mortality rate&#44; 62&#46;2&#37; and 50&#37; respectively&#46; These findings are consistent with the available literature&#44; which indicates that progression and exacerbation of chronic ILD generally denotes a poor outcome once IMV has been instituted&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Fibrotic ILD with CT scan evidence of fibrosis&#44; defined as traction bronchiectasis and honeycombing was associated with a poor outcome&#46; Traction bronchiectasis and honeycombing indicate advanced histopathological alterations&#44; associated with increased lung stiffness&#44; poorer alveolar-capillary gas exchange and greater vulnerability of the lung if IMV is used&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">There was a low rate of lung biopsy&#44; probably reflecting concern about the risk of increased morbidity and mortality associated with this procedure&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The institution of IMV in these patients may raise philosophical questions and would be a procedure to debate&#44; with individualized indications&#44; mostly in cases where the disease is not very advanced or in lung transplant candidates&#46; Physicians should discuss with patients and their relatives the level and degree of life support in case of clinical worsening and ICU admission with IMV should be needed&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Research letter
Interstitial lung disease in the intensive unit care setting
A.F. Gonçalvesa,
Corresponding author
ana_f_goncalves@hotmail.com

Corresponding author.
, S. Campainhab, C. Nogueirac, F. Costad, P. Castelõesc, S. Nevesb
a Centro Hospitalar Vila Nova de Gaia/E, EPE, Vila Nova de Gaia, Portugal
b Centro Hospitalar Vila Nova de Gaia – Pulmonology Department, Portugal
c Centro Hospitalar Vila Nova de Gaia – Intensive Unit Care, Portugal
d Centro Hospitalar Vila Nova de Gaia – Radiology Department, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Interstitial lung diseases &#40;ILD&#41; are a heterogeneous group of disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Although the disease remains stable in some patients&#44; episodes of acute respiratory failure &#40;ARF&#41; requiring invasive mechanical ventilation &#40;IMV&#41; are observed&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Acute respiratory failure is often the result of disease progression or an acute exacerbation&#44; but occasionally occurs as an inaugural manifestation or as an adverse reaction to treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We conducted a retrospective cohort study including patients admitted into ICU&#44; with previously known ILD diagnosis and as an inaugural event&#44; between January 2004 and May 2015&#44; in order to evaluate the clinical outcome&#44; overall survival and prognostic factors of ILD patients in the ICU setting&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Thirty seven patients were included&#44; 27 &#40;73&#37;&#41; were male&#46; Mean age of 65&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;1 years &#40;min&#58; 27&#59; max&#58; 83&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Thirty &#40;81&#46;1&#37;&#41; patients were admitted with previous ILD diagnosis&#46; The diagnoses of the patients admitted in ICU were&#58; 5 &#40;13&#46;5&#37;&#41; idiopathic pulmonary fibrosis &#40;IPF&#41;&#59; 5 &#40;13&#46;5&#37;&#41; silicosis&#59; 5 &#40;13&#46;5&#37;&#41; fibrotic unclassifiable ILD&#59; 5 &#40;13&#46;5&#37;&#41; small vessel vasculitis &#40;ANCA &#43;&#41;&#59; 4 &#40;10&#46;8&#37;&#41; chronic hypersensitivity pneumonitis&#59; 3 &#40;8&#46;2&#37;&#41; sarcoidosis&#59; 2 &#40;5&#46;5&#37;&#41; rheumatoid lung &#40;RL&#41;&#59; 2 &#40;5&#46;5&#37;&#41; acute interstitial pneumonitis&#59; 2 &#40;5&#46;5&#37;&#41; unclear ILD&#59; 2 &#40;5&#46;5&#37;&#41; cryptogenic organizing pneumonia &#40;COP&#41;&#59; 1 &#40;2&#46;7&#37;&#41; scleroderma lung and 1 &#40;2&#46;7&#37;&#41; dermatomyositis&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Seventeen had received previous therapy with corticosteroids&#44; 8 immunosuppressant therapy and 10 long term oxygen therapy&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The median length of ICU and hospital stay were 10 days &#40;min&#58; 1&#59; max&#58; 64&#41; and 21 days &#40;min&#58;1&#59; max&#58;100&#41; respectively&#46; Mean APACHE II score was 18&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7 and mean SAPS II was 36&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;5&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Four lung biopsies were performed&#58; 1 surgical lung biopsy and 3 core needle biopsies guided by CT scan&#46; Two of the biopsies were consistent with acute interstitial pneumonitis&#44; 1 with COP and 1 was unclear&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Seventeen &#40;45&#46;9&#37;&#41; patients had acute exacerbation and twenty experienced ARF due to rapid deterioration of disease associated with respiratory infection&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Thirty three patients &#40;89&#46;2&#37;&#41; required IMV&#44; with an median duration of 10 days &#40;min&#58; 1&#59; max&#58; 62&#41;&#46; Nine &#40;24&#46;3&#37;&#41; underwent non-invasive ventilation prior to IMV&#44; 6 required tracheostomy and 3 extracorporeal membrane oxygenation&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Thirty two patients &#40;86&#46;5&#37;&#41; were treated with antibiotics&#44; 21 &#40;56&#46;8&#37;&#41; with corticosteroids&#44; 8 &#40;21&#46;6&#37;&#41; with antifungals&#44; 6 &#40;16&#46;2&#37;&#41; with cyclophosphamid&#44; 6 &#40;16&#46;2&#37;&#41; with antivirals&#44; 2 &#40;5&#46;4&#37;&#41; with plasmapheresis and 1 &#40;2&#46;7&#37;&#41; with rituximab&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Fourteen &#40;37&#46;8&#37;&#41; patients were discharged from the ICU&#58; 4 small vessel vasculitis &#40;ANCA&#43;&#41;&#59; 3 silicosis&#59; 2 sarcoidosis&#59; 2 COP&#59; 1 fibrotic unclassifiable ILD&#59; 1 RL and 1 scleroderma lung&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Twenty three 23 patients &#40;62&#46;2&#37;&#41; died in ICU&#58; IPF &#40;5&#41;&#59; chronic hypersensitivity pneumonitis &#40;4&#41;&#59; fibrotic unclassifiable ILD &#40;4&#41;&#59; silicosis &#40;2&#41;&#59; acute interstitial pneumonitis &#40;2&#41;&#59; unclear ILD &#40;2&#41;&#59; sarcoidosis &#40;1&#41;&#59; small vessel vasculitis &#40;ANCA &#43;&#41; &#40;1&#41;&#59; RL &#40;1&#41;&#59; dermatomyositis &#40;1&#41;&#46; Short term mortality &#40;first month&#41; and overall hospital mortality were 50&#37; &#40;7 patients&#41; and 86&#46;5&#37; &#40;32 patients&#41; respectively&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Four patients did not require IMV&#58; 1 had COP&#44; 1 unclassifiable ILD&#44; 1 small vessel vasculitis &#40;ANCA&#43;&#41; and 1 RL&#46; From this set of patients only the one with small vessel vasculitis &#40;ANCA&#43;&#41; remains alive&#44; the others died in hospital after ICU discharge&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A fibrotic ILD with traction bronchiectasis and honeycombing was associated with a worse outcome &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031&#41;&#44; as well as the need of IMV &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#41;&#46; A worse outcome was not associated with a higher APACHE II score &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;198&#41;&#44; a higher SAPS II score &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;713&#41;&#44; previous oxygen therapy &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;353&#41; or previous immunosuppressant therapy &#40;0&#46;982&#41;&#46; None of the other parameters analyzed were associated with a worse outcome probably due to the small sample size &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">We found a high ICU and short term mortality rate&#44; 62&#46;2&#37; and 50&#37; respectively&#46; These findings are consistent with the available literature&#44; which indicates that progression and exacerbation of chronic ILD generally denotes a poor outcome once IMV has been instituted&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Fibrotic ILD with CT scan evidence of fibrosis&#44; defined as traction bronchiectasis and honeycombing was associated with a poor outcome&#46; Traction bronchiectasis and honeycombing indicate advanced histopathological alterations&#44; associated with increased lung stiffness&#44; poorer alveolar-capillary gas exchange and greater vulnerability of the lung if IMV is used&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">There was a low rate of lung biopsy&#44; probably reflecting concern about the risk of increased morbidity and mortality associated with this procedure&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The institution of IMV in these patients may raise philosophical questions and would be a procedure to debate&#44; with individualized indications&#44; mostly in cases where the disease is not very advanced or in lung transplant candidates&#46; Physicians should discuss with patients and their relatives the level and degree of life support in case of clinical worsening and ICU admission with IMV should be needed&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;639&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;28&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;71&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IMV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#47;100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#47;28&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;71&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;28&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
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Original language: English
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