Acute Hypoxemic Respiratory Failure: Idiopathic Pulmonary Fibrosis
Idiopathic pulmonary fibrosis (IPF) is a disease characterized by widespread fibrotic and inflammatory abnormalities of the lung. A multidisciplinary approach is particularly important when deciding to perform additional diagnosis assessments, integrating biopsy results with clinical and CT feature. Respiratory failure is a common complication in advanced stages: oxygen supplementation and ventilator support need to be titrated according to the severity of ARF. High-Flow Nasal oxygen may be an alternative to conventional oxygen therapy in patients requiring high-flow and high oxygen concentration to correct hypoxemia and control dyspnea. Neither Non-Invasive Ventilation (NIV) nor Invasive Mechanical Ventilation (IMV) seem to change the poor outcomes associate to advanced stages of IPF, however, in selected patients, such as those with less severe ARF a NIV trial might help in the patients who may present a better short-term prognosis. More invasive techniques, including IMV and Extracorporeal Membrane Oxygenation (ECMO) should be limited to patients listed for lung transplant.