Interstitial lung diseases (ILDs) may be complicated by chronic respiratory failure (CRF), especially in the advanced stages. Aim of this narrative review is to evaluate the current evidence in management of CRF in ILDs.Many physiological mechanisms underlie CRF in ILDs, including lung restriction, ventilation/perfusion mismatch, impaired diffusion capacity and pulmonary vascular damage. Intermittent exertional hypoxemia is often the initial sign of CRF, evolving, as ILD progresses, into continuous hypoxemia. In the majority of the cases, the development of CRF is secondary to the worsening of the underlying disease; however, associated comorbidities may also play a role. When managing CRF in ILDs, the need for pulmonary rehabilitation, the referral to lung transplant centers and palliative care should be assessed and, if necessary, promptly offered. Long-term oxygen therapy is commonly prescribed in case of resting or exertional hypoxemia with the purpose to decrease dyspnea and improve exercise tolerance. High-Flow Nasal Cannula oxygen therapy may be used as an alternative to conventional oxygen therapy for ILD patients with severe hypoxemia requiring both high flows and high oxygen concentrations. Non-Invasive Ventilation may be used in the chronic setting for palliation of end-stage ILD patients, although the evidence to support this application is very limited.

Faverio, P., De Giacomi, F., Bonaiti, G., Stainer, A., Sardella, L., Pellegrino, G., et al. (2019). Management of Chronic Respiratory Failure in Interstitial Lung Diseases: Overview and Clinical Insights. INTERNATIONAL JOURNAL OF MEDICAL SCIENCES, 16(7), 967-980 [10.7150/ijms.32752].

Management of Chronic Respiratory Failure in Interstitial Lung Diseases: Overview and Clinical Insights

Faverio, Paola;De Giacomi, Federica;Bonaiti, Giulia;Stainer, Anna;Sardella, Luca;Messinesi, Grazia;Pesci, Alberto
2019

Abstract

Interstitial lung diseases (ILDs) may be complicated by chronic respiratory failure (CRF), especially in the advanced stages. Aim of this narrative review is to evaluate the current evidence in management of CRF in ILDs.Many physiological mechanisms underlie CRF in ILDs, including lung restriction, ventilation/perfusion mismatch, impaired diffusion capacity and pulmonary vascular damage. Intermittent exertional hypoxemia is often the initial sign of CRF, evolving, as ILD progresses, into continuous hypoxemia. In the majority of the cases, the development of CRF is secondary to the worsening of the underlying disease; however, associated comorbidities may also play a role. When managing CRF in ILDs, the need for pulmonary rehabilitation, the referral to lung transplant centers and palliative care should be assessed and, if necessary, promptly offered. Long-term oxygen therapy is commonly prescribed in case of resting or exertional hypoxemia with the purpose to decrease dyspnea and improve exercise tolerance. High-Flow Nasal Cannula oxygen therapy may be used as an alternative to conventional oxygen therapy for ILD patients with severe hypoxemia requiring both high flows and high oxygen concentrations. Non-Invasive Ventilation may be used in the chronic setting for palliation of end-stage ILD patients, although the evidence to support this application is very limited.
No
Articolo in rivista - Articolo scientifico
Scientifica
Interstitial lung diseases; chronic respiratory failure; idiopathic pulmonary fibrosis; non-invasive ventilation; oxygen therapy
English
967
980
14
Faverio, P., De Giacomi, F., Bonaiti, G., Stainer, A., Sardella, L., Pellegrino, G., et al. (2019). Management of Chronic Respiratory Failure in Interstitial Lung Diseases: Overview and Clinical Insights. INTERNATIONAL JOURNAL OF MEDICAL SCIENCES, 16(7), 967-980 [10.7150/ijms.32752].
Faverio, P; De Giacomi, F; Bonaiti, G; Stainer, A; Sardella, L; Pellegrino, G; Sferrazza Papa, G; Bini, F; Bodini, B; Carone, M; Annoni, S; Messinesi, G; Pesci, A
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