NIV In Diffuse Interstitial Lung Disease
Patients with Diffuse Interstitial Lung Disease (DILD) undergoing an episode of acute respiratory failure (ARF), the improvement in gas exchange during NIV treatment depends on the etiology of the ARF, but not the radiological pattern of DILD.
NIV treatment should be individualized in patients with DILD undergoing an episode of ARF according to the etiology, but the radiological pattern. A trial of NIV may be considered in patients with ARF caused by pneumonia in order to improve gas exchange, although no favorable impact on clinical outcomes has been proven so far.
An improvement in oxygenation during NIV is detected when pneumonia, but exacerbation of fibrosis, is the triggers of ARF. The occurrence of a clinical failure can be identified in 37% of DILD patients undergoing NIV.
NIV is used in this population of patients due to several data showing high rates of mortality in patients with DILD undergoing intubation in the ICU.
A special indication for NIV in DILD might be in those patients who have an indication for lung transplant, although no data has been published on this topic. NIV is not a contraindication for lung transplantation as prolonged invasive ventilation is. Moreover, NIV may theoretically work as a "bridge" for patients on waiting list for lung transplantation as it has been shown for other chronic rapid - evolving lung diseases, such as cystic fibrosis.
