Pulmonary fibrosis: which patient should be admitted to the ICU and based on which criteria?

Abstract

Pulmonary fibrosis is a severe and complex condition that belongs to the general spectrum of interstitial lung diseases. Exacerbation of idiopathic pulmonary fibrosis is a significant determinant of poor patient outcome. When exacerbation is severe enough to require intensive care unit (ICU) admission, concerns exist due to the lack of effective therapy. Admission to the ICU of a patient with a known diagnosis of idiopathic pulmonary fibrosis should be discussed depending on whether the patient is listed for lung transplantation as well as on the etiological investigations performed in the setting of acute deterioration. Patients with acute worsening due to severe pulmonary arterial hypertension may also be admitted to the ICU for specific management. Wether the patient is admitted to the ICU, the intensity of initial management should not be restricted. The level of care should be rapidly discussed with the pulmonologist and the family, taking into account the results of the etiological investigations.