Noninvasive Oxygenation Strategies For Acute Exacerbation of Interstitial Lung Disease: A Retrospective Single-center Study and a Review of the Literature

Acute exacerbation of interstitial lung disease (AE-ILD) causes severe respiratory failure so that the patients would often require mechanical ventilation. Mechanical ventilation may improve survival in selected patients with AE-ILD; however, in-hospital mortality rate is so high in patients who need mechanical ventilation that the use of mechanical ventilation is weakly recommended. Although there is no fixed strategy with regard to selection of oxygen devices, a palliative approach to how to spend the end-of-life periods is often needed. Although noninvasive ventilation may be used to avoid intubation, high-flow nasal cannula (HFNC) was developed in recent years and has been feasible and useful for acute respiratory failure of various causes. In terms of the quality of life, moreover, HFNC systems are associated with patient comfort and tolerance and more ability for oral intake of nutrition and less occurrence of cognitive dysfunction or coma. HFNC has broad utility, and it is likely that usage will increase more and more in the future. Limited data of its use in AE-ILD are available, and further study will be necessary.