Zhan Liang1, Leslie A Hoffman2, Mehdi Nouraie3,4, Daniel J Kass3,4, Michael P Donahoe3,5, Kevin F Gibson3,4, Melissa I Saul5, Kathleen O Lindell3,4. 1. 1 University of South Florida College of Nursing , Tampa, Florida. 2. 2 University of Pittsburgh School of Nursing , Pittsburgh, Pennsylvania. 3. 3 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania. 4. 4 The University of Pittsburgh Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at UPMC , Pittsburgh, Pennsylvania. 5. 5 Department of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.
Abstract
BACKGROUND: Palliative care has been recommended as a means to assist patients with idiopathic pulmonary fibrosis (IPF) in managing symptom burden and advanced care planning. Timing of referral is important because although most patients display a gradually progressive course, a minority experience acute deterioration, an outcome associated with high mortality. AIM: To describe characteristics of IPF patients referred to a specialty lung disease center over a 10-year period who experienced acute deterioration and subsequent intensive care unit (ICU) admission, including frequency and timing of referral to palliative care. DESIGN: Retrospective review. SETTING/PARTICIPANTS: We identified 106 patients admitted to the ICU with acute deterioration due to a respiratory or nonrespiratory cause. Variables examined included demographics, date of first center visit, forced vital capacity, diffusing capacity of the lung for carbon monoxide (DLCO), and palliative care referral. RESULTS: ICU admission occurred early (median 9.5 months) and, for 34%, within four months of their first center visit. For nearly one-half of these patients, ICU admission occurred before their third clinic visit. Only 4 (3.8%) patients received a palliative care referral before ICU admission. The majority (77%) died during ICU admission. With exception of the relationship between DLCO% predicted at first visit and time to ICU admission (r = 0.32, p = 0.005), no variables identified those most likely to experience acute deterioration. CONCLUSION: Due to high mortality associated with ICU admission, patients and families should be informed about palliative care early following diagnosis of IPF.
BACKGROUND: Palliative care has been recommended as a means to assist patients with idiopathic pulmonary fibrosis (IPF) in managing symptom burden and advanced care planning. Timing of referral is important because although most patients display a gradually progressive course, a minority experience acute deterioration, an outcome associated with high mortality. AIM: To describe characteristics of IPF patients referred to a specialty lung disease center over a 10-year period who experienced acute deterioration and subsequent intensive care unit (ICU) admission, including frequency and timing of referral to palliative care. DESIGN: Retrospective review. SETTING/PARTICIPANTS: We identified 106 patients admitted to the ICU with acute deterioration due to a respiratory or nonrespiratory cause. Variables examined included demographics, date of first center visit, forced vital capacity, diffusing capacity of the lung for carbon monoxide (DLCO), and palliative care referral. RESULTS: ICU admission occurred early (median 9.5 months) and, for 34%, within four months of their first center visit. For nearly one-half of these patients, ICU admission occurred before their third clinic visit. Only 4 (3.8%) patients received a palliative care referral before ICU admission. The majority (77%) died during ICU admission. With exception of the relationship between DLCO% predicted at first visit and time to ICU admission (r = 0.32, p = 0.005), no variables identified those most likely to experience acute deterioration. CONCLUSION: Due to high mortality associated with ICU admission, patients and families should be informed about palliative care early following diagnosis of IPF.
Entities:
Keywords:
advanced care planning; idiopathic pulmonary fibrosis; intensive care unit; palliative care
Authors: Kathleen Oare Lindell; Sara Jo Klein; Melinda S Veatch; Kevin F Gibson; Daniel J Kass; Mehdi Nouraie; Margaret Q Rosenzweig Journal: Ann Am Thorac Soc Date: 2021-11
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Authors: Catharina C Moor; Nelleke C Tak van Jaarsveld; Catherine Owusuaa; Jelle R Miedema; Sara Baart; Carin C D van der Rijt; Marlies S Wijsenbeek Journal: Respiration Date: 2021-05-27 Impact factor: 3.580