Background

The clinical course of ILD patients presenting with ARF is often unpredictable due to poor prognosis.NHFT is used to treat ARF but the efficacy and clinical outcomes in this cohort is limited.

Aims

To evaluate clinical outcomes,NHFT duration,survival rate(7 and 30 day) and clinical predictors between survivors and non survivors at 30 days.

Method

ILD patients with refractory ARF (Po2 of < 8) were considered for NHFT.Patients were retrospectively identified from the database (2017-2022).The NHFT settings were tailored to patient?s comfort and target saturations.

Results

Patients(n=45,Age-72+/-12,BMI-28+/-7,FVC%-77+/-26,DLCO%-46+/-16) were initiated on NHFT.78% had a smoking history,84% had a pre-existing diagnosis of ILD.The median time from MDT diagnosis to admission was 16 months,UIP(31%) being the commonest.Mean Po2 prior to NHFT was 8+/-1.8 kpa and the median duration of NHFT was 4 days.18% were escalated to either CPAP or NIV and 9% had invasive mechanical ventilation.The 7 and 30 days mortality were 51% and 69%.Subgroup analysis did not show any significant clinical parameters that predicts survival(Table1).

Conclusion

NHFT is an option in ILD patients with ARF but carries high mortality.Our data suggests no clinical parameters can predict survival and thus the progression is unpredictable.A patient centred pragmatic clinical approach including palliative care should be considered.