Chest
Clinical Investigations in Critical CareOutcome of Patients With Idiopathic Pulmonary Fibrosis Admitted to the ICU for Respiratory Failure
Section snippets
Selection of Patients
We retrospectively studied all consecutive patients with IPF who were referred to the respiratory ICU of Croix-Rousse Hospital, Lyon, France, for ARF, from January 1989 to June 1998. The definition of ARF was as follows: (1) exacerbation of dyspnea within a few days, (2) deterioration of hypoxemia (Pao2/fraction of inspired oxygen< 250), and (3) MV requirement. The diagnosis of IPF was based on a combination of the following criteria: persistent bilateral dry crackles on auscultation;
Characteristics of the Patients
Fifteen patients (11 men) were included (Table 1). Eight patients had clinical, functional, and radiologic features of IPF. Seven of them were known to have IPF at the time of admission, whereas in one patient the diagnosis of IPF was made during the ICU stay. In the seven remaining patients, the diagnosis of IPF was established by lung biopsy specimen, in addition to clinical symptoms; the biopsies were performed before ICU admission in six patients, and during ICU stay in one patient. In all
Discussion
In our study, the diagnosis of IPF was based on major clinical and radiologic criteria in eight patients10 and was definitely established by open-lung biopsy specimens in the remaining seven patients. Although surgical lung biopsy is the most reliable procedure to provide a definite diagnosis of IPF, it has been demonstrated that HRCT characteristics of IPF in an appropriate clinical context lead to a correct diagnosis in 85 to 90% of cases.5,8,15 The diagnosis of the ARDS could also be
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