Acute exacerbation of interstitial lung disease in the intensive care unit: Principles of diagnostic evaluation and management

Abstract

Interstitial lung disease (ILD) is typically managed on an outpatient basis. Critical care physicians manage patients with ILD in the setting of an acute exacerbation (ILD flare) causing severe hypoxia. The principles of management of acute exacerbation of ILD are different from those used to manage patients with acute respiratory distress syndrome from sepsis, etc. Selected patients may be candidates for aggressive measures like extracorporeal membrane oxygenation and lung transplantation, while almost all patients will benefit from early palliative care. This review focused on the types of ILD, diagnosis, and management pathways for this challenging condition.

Keywords: Interstitial lung disease, Pulmonary fibrosis, Acute exacerbation of interstitial lung disease, Extracorporeal membrane oxygenation, Interstitial lung disease flare, Immunosuppression

Core Tip: Interstitial lung disease (ILD) refers to a heterogeneous group of parenchymal lung disorders. Most patients with ILD receive management in outpatient clinics. Patients with acute exacerbation of ILD may experience significant respiratory distress, requiring urgent management in an intensive care unit. Timely diagnosis and management of these patients using a multimodality team approach may improve both morbidity and mortality. When acute exacerbation of ILD progresses to irreversible end-stage respiratory failure, lung transplantation and/or palliative care may be appropriate treatment options depending on the individual patient’s clinical presentation.