Correct!
3. Idiopathic

Acute exacerbation is one of the main prognostic factors predicting increased mortality of ILD patients. For instance, the mortality rate of acute exacerbation in IPF patients is 60~100%, and it is the main cause of death. The definition of an acute exacerbation in ILD patients includes the following criteria (2).

• Concurrent diagnosis of interstitial lung disease;
• Aggravating symptoms;
• Hypoxemia worse that pre-exacerbation (decreased PaO2/FiO2);
• New ground glass opacities or consolidations on images;
• Exclusion of other causes that can cause aggravation of symptoms such as infection, pulmonary hypertension, congestive heart failure and pulmonary embolism.

Multiple factors including infection, pulmonary embolism, heart failure, chemo- or radio-therapy for lung cancer, BAL, and complication of immune suppressing agents, can exacerbate underlying ILD, however a clear etiology cannot be found in the majority of ILD patients with acute exacerbation. Several hypothesis such as genetic factors, occult aspiration and viral infection have been suggested although no clear evidence to support any of these (2).

The patient is now on mechanical ventilator in the volume control mode with a positive end expiratory pressure (PEEP) of 14 cm H2), respiratory rate 14 breaths/min, tidal volume (TV) 380 ml, and the fraction of inspired oxygen (FiO2) of 60%. ABGs were as follows:

ABG: pH 7.34, pCO2 45.4 mmHg, pO2 168.3 mmHg HCO3- 24.8 meq/L, SaO2 96.3 %

What is the most appropriate ventilator mode in diffuse interstitial lung disease? (click on correct answer to move to next panel)

1. High PEEP, high tidal volume
2. High PEEP, low tidal volume
3. Low PEEP, high tidal volume
4. Low PEEP, low tidal volume
5. None of the above

Home/Critical Care