Interstitial pneumonia with autoimmune features: an additional risk factor for ARDS?
| Autor: | Vittorio Scaravilli, Antonio Pesenti, Alberto Pesci, Vittoria Sala, Gabriele D'Andrea, Marco Mantero, Maria Rosa Pozzi, Beatrice Vergnano, Giacomo Grasselli |
|---|---|
| Přispěvatelé: | Grasselli, G, Vergnano, B, Pozzi, M, Sala, V, Dâ andrea, G, Scaravilli, V, Mantero, M, Pesci, A, Pesenti, A |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
ARDS Population Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine Internal medicine Anesthesiology medicine Interstitial pneumonia with autoimmune feature Risk factor Intensive care medicine education education.field_of_study business.industry Research Interstitial pneumonia with autoimmune features Autoantibody Interstitial lung disease lcsh:Medical emergencies. Critical care. Intensive care. First aid 030208 emergency & critical care medicine lcsh:RC86-88.9 medicine.disease Connective tissue disease 030228 respiratory system Etiology ECMO business Lung-dominant connective tissue disease |
| Zdroj: | Annals of Intensive Care, Vol 7, Iss 1, Pp 1-10 (2017) Annals of Intensive Care |
| Popis: | Background Interstitial pneumonia with autoimmune features (IPAF) identifies a recently recognized autoimmune syndrome characterized by interstitial lung disease and autoantibodies positivity, but absence of a specific connective tissue disease diagnosis or alternative etiology. We retrospectively reviewed the clinical presentation, diagnostic workup and management of seven critically ill patients who met diagnostic criteria for IPAF. We compared baseline characteristics and clinical outcome of IPAF patients with those of the population of ARDS patients admitted in the same period. Results Seven consecutive patients with IPAF admitted to intensive care unit for acute respiratory distress syndrome (ARDS) were compared with 78 patients with ARDS secondary to a known risk factor and with eight ARDS patients without recognized risk factors. Five IPAF patients (71%) survived and were discharged alive from ICU: Their survival rate was equal to that of patients with a known risk factor (71%), while the subgroup of patients without risk factors had a markedly lower survival (38%). According to the Berlin definition criteria, ARDS was severe in four IPAF patients and moderate in the remaining three. All had multiple organ dysfunction at presentation. The most frequent autoantibody detected was anti-SSA/Ro52. All patients required prolonged mechanical ventilation (median duration 49 days, range 10–88); four received extracorporeal membrane oxygenation and one received low-flow extracorporeal CO2 removal. All patients received immunosuppressive therapy. Conclusions This is the first description of a cohort of critical patients meeting the diagnostic criteria for IPAF presenting with ARDS. This diagnosis should be considered in any critically ill patient with interstitial lung disease of unknown origin. While management is challenging and level of support high, survival appears to be good and comparable to that of patients with ARDS associated with a known clinical insult Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0320-3) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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