Delaying intubation after initiating high-concentration oxygen therapy in patients with idiopathic pulmonary fibrosis (IPF) can significantly increase the risk of intensive care unit (ICU) mortality, according to a study published in Acute and Critical Care. 

Patients with IPF often experience acute exacerbations that require immediate medical attention. As the field of critical medical care progresses, more and more patients with IPF are given mechanical ventilatory support even though mechanical ventilation is associated with higher rates of mortality. 

Another form of therapy commonly initiated in IPF respiratory dysfunction is high-flow oxygen therapy. The downside of this form of therapy, however, is that it may delay intubation, which can potentially worsen outcomes. The authors of this study investigated the relationship between the timing of intubation and clinical outcomes in patients with IPF. 


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The retrospective study collected the medical data of patients with IPF who were admitted to the ICU and received mechanical ventilatory support between January 2011 and July 2021. The inclusion criteria included a diagnosis of IPF according to American Thoracic Society guidelines; patients must also have been administered high-concentration oxygen therapy prior to intubation. Follow-up data must also have been available until discharge or death. 

Researchers discovered that delayed intubation (defined as tracheal intubation initiated 48 hours after the commencement of high-concentration oxygen therapy) was associated with significantly higher ICU mortality compared with patients who received early intubation.

“Therefore, as with other causes of respiratory failure, tracheal intubation should not be delayed if needed in IPF patients who have failed high-concentration oxygen therapy, especially when lung [transplantation] is being considered,” the authors concluded. 

Reference

Bae E, Park J, Choi SM, Lee J, Lee SM, Lee HY. Association between timing of intubation and mortality in patients with idiopathic pulmonary fibrosisAcute Crit Care. 2022;10.4266/acc.2022.00444. doi:10.4266/acc.2022.00444