Impact of oxygenation strategies on outcome in acute exacerbation of interstitial lung disease.

Rationale: The benefit of noninvasive ventilation (NIV) in hypoxaemic acute respiratory failure is controversial 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) also deserve to be evaluated in AE-ILD. Methods: We aimed to describe the respiratory management and compare outcome of adult patients with AE-ILD according to the initial oxygenation strategies, i.e. within 48 h of admission: HFNC alone or NIV±HFNC. Results: A multicentre retrospective study has been conducted in intensive care units of four French tertiary hospitals between 1 January 2010 and 31 December 2021 with in-hospital mortality as primary outcome. Among 3962 screened patients, 163 were included: 118 with HFNC and 45 with NIV±HFNC. Analysis of changes in oxygenation strategy applied over the past decade have shown an increase in the use of HFNC, from 33.3% in 2010 to 79.2% in 2020. The adjusted in-hospital mortality rate was 55.2% (95% CI 36.0-74.4%) in the NIV±HFNC group versus 45.9% (95% CI 36.5-55.4%) in the HFNC group (p=0.39). The adjusted intubation rates were 25.9% and 36.9% in the HFNC and NIV±HFNC groups, respectively (p=0.26). Conclusion: The management of AE-ILD has progressively include the HFNC use during the past decade, despite the lack of evidence in the literature. Our study did not find any superiority of HFNC compared with NIV±HFNC in AE-ILD outcome but deserve further prospective trials with a larger population.