Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive and fatal disease. The treatment is challenging and nowadays a comprehensive approach based not only in pharmacological strategies is necessary. Identification and control of comorbidities, non-pharmacological treatment, prevention and management of exacerbations as well as other areas of care (social, psychological) are fundamental for a holistic management of IPF. Gastroesophageal reflux, pulmonary hypertension, obstructive sleep apnea, combined with emphysema, lung cancer and cardiovascular involvement are the main comorbidities associated with IPF. Non-pharmacological treatment includes the use of oxygen in patients with rest or nocturnal hypoxemia and other support therapies such as non-invasive ventilation or even a high-flow nasal cannula to improve dyspnea. In some patients, lung transplant should be considered as this enhances survival. Pulmonary rehabilitation can add benefits in outcomes such control of dyspnea, exercise capacity distance and, overall, improve the quality of life; therefore it should be considered in patients with IPF. Also, multidisciplinary palliative care programs could help with symptom control and psychological support, with the aim of maintaining quality of life during the whole process of the disease. This review intends to provide clear information to help those involved in IPF follow up to improve patients’ daily care.

https://www.mdpi.com/2076-3271/6/3/59/pdf/1

Comorbidities, Complications and Non-Pharmacologic Treatment in Idiopathic Pulmonary Fibrosis

Ventilator Settings and Outcome of Respiratory Failure in Chronic Interstitial Lung Disease. Commentary

The Other Side of the Bridge

[Extracorporeal membrane oxygenation for treatment of acute respiratory failure : Outcome of patients with interstitial lung disease].

Patients suffering from interstitial lung disease (ILD) share a number of similarities with chronic obstructive pulmonary disease (COPD) patients. The natural evolution in both patient groups is a slow deterioration of lung capacity punctuated by exacerbations, and available treatments are mostly aimed at sustaining lung capacity and preventing exacerbations. Additionally, the last treatment option is lung transplantation (LTx), which is usually performed, in chronic, stable patients. However, management discrepancies are noted between the two patient groups regarding intensive care unit (ICU) admission policy.

/pdf/extracorporeal-membrane-oxygenation-for-interstitial-lung-10kctr22hq.pdf

Extracorporeal membrane oxygenation for interstitial lung disease: what is on the other side of the bridge?

In a recent issue of Intensive Care Medicine , Ouweneel et al . provided a meta-analysis on extracorporeal life support (ECLS) during cardiac arrest (CA) and cardiogenic shock (1). Cardiogenic shock analysis compared ECLS vs. Impella, TandemHeart, or intra-aortic balloon pump (IABP). As these devices have various support levels, different specifications, and therefore different clinical indications, results issued from this analysis are clinically questionable. In addition, based on the recent IABP Shock II trial (2), current European guidelines on cardiogenic shock no longer support routine IABP therapy use, except for mechanical complications (class IIaC). As reported by the authors, caution is required in interpreting this part of the meta-analysis and our interest was therefore focused on the evaluation of ECLS during CA.

/pdf/meta-analysis-on-extracorporeal-life-support-during-cardiac-5e2phst9wo.pdf

Sacha Rozencwajg

Papers

Extracorporeal membrane oxygenation for interstitial lung disease: what is on the other side of the bridge?

Meta-analysis on extracorporeal life support during cardiac arrest: do not compare apples and oranges.