Physiological impact of non-invasive respiratory support during acute exacerbation of interstitial lung disease

Résumé fourni par la source

Introduction: Acute exacerbation (AE) is a fatal complication of interstitial lung pneumonia (ILD). We have studied the risk of patient self-inflicted lung injury (P-SILI) with non-invasive respiratory support (NIRS) in AE-ILD, according to the severity of acute respiratory failure (ARF). Methods: We conducted a study on a computerized lung representing the characteristics of severe ILD in AE. We studied the impact of face mask (FM), continuous positive airway pressure (CPAP), non-invasive ventilation (NIV) and high flow oxygen therapy (HFOT) according to the severity of ARDS. We studied : tidal volume (TV), end-expiratory lung volume (EELV), lung volume due to positive expiratory pressure (VPEP), total PEEP (PEEPtot), end-inspiratory transpulmonary pressure (TPend-inspi) and expiratory (TPend-exp), total transpulmonary pressure (ΔPTP), driving pressure (ΔP), alveolar strain (strainalv), mechanical power (MP), work of breathing (WOB) and end-tidal carbon dioxide (ETCO2). Results: In severe ARF, VPEP, PEPtot, TPend-exp, TPend-inspi and ΔP were higher under CPAP and NIV compared with other NIRS. Strainalv and PM exceeded the thresholds of 1.5 ml and 17 J/min, respectively, for all NIRS. For moderate ARF, the trends of the previous parameters were identical except for strainalv (< 1.5 ml for all NIRS) and PM < 17 J/min for CPAP. For mild ARF, PM and strainalv were lower under HFOT while ETCO2 was higher. Conclusion: Our results show that the risk of P-SILI under NIRS depends on the severity of the underlying ARF. The assesment of patient's response under NIRS appears essential to reduce the risk of P-SILI and may be estimate by the ETCO2.

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