The Role of the Respiratory Intermediate Care Unit in Interstitial Lung Disease Exacerbations: A Bridge to Lung Transplantation

Introduction

This study aims to describe the clinical features, hospital management, and outcomes of patients with interstitial lung disease (ILD) and acute respiratory failure (ARF) admitted to the respiratory intermediate care units (RICUs).

Material and methods

An observational study was conducted on ILD patients admitted to the RICU between June 1, 2021, and May 30, 2024. Main variables analysed included demographics, non-invasive respiratory support (NIRS) types, ILD-related variables, lung transplant outcomes, and survival rates.

Results

Of the 401 patients admitted, 51 (13%) had ILD, of whom 34 (67%) were male. Idiopathic pulmonary fibrosis (IPF) was the most common condition (33%), and high-flow oxygen therapy (HFOT) was the primary treatment (94%). Infection (29%) and disease progression (36%) were the main hospitalization causes. Of the 27 patients (53%) evaluated for transplantation, 18 (36%) underwent a lung transplant, with 5 (28%) directly transplanted from the RICU and 55% (N = 15) were added to the emergency-driven list. Overall survival rates for ICU-eligible patients were 89% at one month, 77% at six months, and 72% at one year, while non-ICU eligible had lower survival probabilities of 31%, 13%, and 13%, respectively.

Conclusions

The RICU should be considered a bridge therapy for patients who are ICU candidates and eligible for lung transplant during ILD exacerbations, potentially reducing ICU admissions. However, patients who are not ICU candidates face high short- and medium-term mortality risks. The significance of this study highlights the need to establish a specific RICU admission protocol for patients experiencing ILD exacerbations.