Impact of Oxygenation Strategies on Outcome in Acute Exacerbation of Interstitial Lung Disease : A Multicenter Restrospective Study

Introduction: The benefits of noninvasive ventilation (NIV) is debated in hypoxemic ARF, and has never been studied in acute exacerbation of interstitial lung disease (AE-ILD). The potential protective effects of high-flow nasal cannula oxygen therapy (HFNC) deserve to be evaluated in this condition. Aims and Objectives: To compare the outcome of AE-ILD according to their oxygenation strategy used during the first 24 hours following their intensive care unit (ICU) admission : HFNC or NIV associated with HFNC or not. Methods: We conducted a multicenter retrospective study in 4 French tertiary hospitals between 2010 and 2020. The primary outcome was in-hospital mortality between the groups. Results: Among 3962 screened patients, 163 were included. 31.3% of AE-ILD were inaugural. 118 in the HFNC group and 45 in the NIV ± HFNC group. During the study period, the rate of HFNC use increased from 50% to 88.2%. The in-hospital mortality rate was not significantly different between both groups: 45.9% in the HFNC group vs 55.2% in the NIV ± HFNC group (p=0.39). The intubation rate was 25.6% and 36.9% in the HFNC vs NIV ± HFNC group, respectively (p=0.25). No independant prognostic factor was identified for both groups in multivariate analysis. Conclusion: Management of AE-ILD has progressively include HFNC use during the past 10 years, despite the lack of evidence in the literature. Our study did not find any superiority of NIV ± HFNC vs HFNC alone in AE-ILD outcome but deserve further research with more patients.