Idiopathic pulmonary fibrosis - Revision history

Mholtz: Text replacement - "qd" to "QD"

2017-07-07T08:13:45Z

Text replacement - "qd" to "QD"

← Older revision		Revision as of 08:13, 7 July 2017
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	==Management==		==Management==
	*All treatments controversial and of questionable efficacy		*All treatments controversial and of questionable efficacy
	*[[Methylprednisolone]] 500-1000mg qd for 3 days<ref>Rice AJ, Wells AU, Bouros D, Du Bois RM, Hansell DM, Polychronopoulos V, et al. Terminal diffuse alveolar damage in relation to interstitial pneumonias. An autopsy study. Am J Clin Pathol 2003;119:709-14.</ref><ref>Saydain G, Islam A, Afessa B, Ryu JH, Scott JP, Peters SG. Outcome of patients with idiopathic pulmonary fibrosis admitted to the intensive care unit. Am J Respir Crit Care Med 2002;166:839-42.</ref>		*[[Methylprednisolone]] 500-1000mg QD for 3 days<ref>Rice AJ, Wells AU, Bouros D, Du Bois RM, Hansell DM, Polychronopoulos V, et al. Terminal diffuse alveolar damage in relation to interstitial pneumonias. An autopsy study. Am J Clin Pathol 2003;119:709-14.</ref><ref>Saydain G, Islam A, Afessa B, Ryu JH, Scott JP, Peters SG. Outcome of patients with idiopathic pulmonary fibrosis admitted to the intensive care unit. Am J Respir Crit Care Med 2002;166:839-42.</ref>
	*[[Heparin]] drip		*[[Heparin]] drip
	**Alveolar injury predisposes to prothrombotic state		**Alveolar injury predisposes to prothrombotic state

Rossdonaldson1: /* Clinical Features */

2016-12-19T11:46:55Z

Clinical Features

← Older revision		Revision as of 11:46, 19 December 2016
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	*Presentations with rapid deterioration without obvious cause common		*Presentations with rapid deterioration without obvious cause common
	*May co-exist with [[pulmonary hypertension]] and [[heart failure]]		*May co-exist with [[pulmonary hypertension]] and [[heart failure]]
	*Diagnostic criteria for acute exacerbation of IPF:
	**Diagnosis of IPF		===Acute exacerbation of IPF===
	**Unexplained worsening of [[dyspnea]] within 30 days		*Diagnosis of IPF
	**Hypoxemia deviated from baseline ABG		*Unexplained worsening of [[dyspnea]] within 30 days
	**No evidence of pulmonary infection		*Hypoxemia deviated from baseline ABG
	**Exclusion of alternative causes (i.e. VTE)		*No evidence of pulmonary infection
	**CT with bilateral ground-glass abnormalities/consolidation on a background reticular/honeycomb pattern consistent with interstitial [[pneumonia]]<ref>Akira M, Kozuka T, Yamamoto S, Sakatani M. Computed tomography findings in acute exacerbation of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2008;178:372-8.</ref>		*Exclusion of alternative causes (i.e. VTE)
	***100% have bilateral ground-glass opacities		*CT with bilateral ground-glass abnormalities/consolidation on a background reticular/honeycomb pattern consistent with interstitial [[pneumonia]]<ref>Akira M, Kozuka T, Yamamoto S, Sakatani M. Computed tomography findings in acute exacerbation of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2008;178:372-8.</ref>
	***~70% have consolidation		**100% have bilateral ground-glass opacities
			**~70% have consolidation

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1 at 11:45, 19 December 2016

2016-12-19T11:45:52Z

← Older revision		Revision as of 11:45, 19 December 2016
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	*[[Cyclosporine]] A 1-2mg/kg/day with steroids<ref>Meduri GU, Golden E, Freire AX, Taylor E, Zaman M, Carson SJ, et al. Methylprednisolone infusion in early severe ARDS: Results of a randomized controlled trial. Chest 2007;131:954-63.</ref>		*[[Cyclosporine]] A 1-2mg/kg/day with steroids<ref>Meduri GU, Golden E, Freire AX, Taylor E, Zaman M, Carson SJ, et al. Methylprednisolone infusion in early severe ARDS: Results of a randomized controlled trial. Chest 2007;131:954-63.</ref>

	==Mechanical Ventilation Strategies==		===Mechanical Ventilation Strategies===
	*Current strategies controversial, with some contending mechanical ventilation adds insult to AE-IPF		*Current strategies controversial, with some contending mechanical ventilation adds insult to AE-IPF
	*Non-invasive may be use as a temporizing measure		*Non-invasive may be use as a temporizing measure

Rossdonaldson1: Text replacement - "ECG" to "ECG"

2016-09-09T11:15:31Z

Text replacement - "*ECG" to "*ECG"

← Older revision		Revision as of 11:15, 9 September 2016
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	*LDH elevated		*LDH elevated
	*ABG with hypoxemia, hypercapnea		*ABG with hypoxemia, hypercapnea
	*ECG		*[[ECG]]
	*[[CXR]] with likely need for CT		*[[CXR]] with likely need for CT
	*Echo to assess for pulmonary hypertension, rule out CHF		*Echo to assess for pulmonary hypertension, rule out CHF

Rossdonaldson1: Text replacement - "CXR" to "CXR"

2016-09-09T07:31:18Z

Text replacement - "*CXR" to "*CXR"

← Older revision		Revision as of 07:31, 9 September 2016
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	*ABG with hypoxemia, hypercapnea		*ABG with hypoxemia, hypercapnea
	*ECG		*ECG
	*CXR with likely need for CT		*[[CXR]] with likely need for CT
	*Echo to assess for pulmonary hypertension, rule out CHF		*Echo to assess for pulmonary hypertension, rule out CHF
	*BAL in ICU to rule out infection		*BAL in ICU to rule out infection

Rossdonaldson1: Text replacement - "HTN" to "hypertension"

2016-07-31T09:26:40Z

Text replacement - "HTN" to "hypertension"

← Older revision		Revision as of 09:26, 31 July 2016
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	*ECG		*ECG
	*CXR with likely need for CT		*CXR with likely need for CT
	*Echo to assess for pulmonary ~~HTN~~, rule out CHF		*Echo to assess for pulmonary hypertension, rule out CHF
	*BAL in ICU to rule out infection		*BAL in ICU to rule out infection

Rossdonaldson1: Text replacement - "pulm " to "pulmonary "

2016-07-30T22:27:30Z

Text replacement - "pulm " to "pulmonary "

← Older revision		Revision as of 22:27, 30 July 2016
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	*ECG		*ECG
	*CXR with likely need for CT		*CXR with likely need for CT
	*Echo to assess for ~~pulm~~ HTN, rule out CHF		*Echo to assess for pulmonary HTN, rule out CHF
	*BAL in ICU to rule out infection		*BAL in ICU to rule out infection

Rossdonaldson1: Text replacement - "r/o" to "rule out"

2016-07-30T16:00:00Z

Text replacement - "r/o" to "rule out"

← Older revision		Revision as of 16:00, 30 July 2016
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	*ECG		*ECG
	*CXR with likely need for CT		*CXR with likely need for CT
	*Echo to assess for pulm HTN, ~~r/o~~ CHF		*Echo to assess for pulm HTN, rule out CHF
	*BAL in ICU to ~~r/o~~ infection		*BAL in ICU to rule out infection

	==Management==		==Management==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-22T18:48:07Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 18:48, 22 July 2016
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	{{Pulmonary fibrosis differential}}		{{Pulmonary fibrosis differential}}

	==~~Diagnosis~~==		==Evaluation==
	*CBC, leukocytosis		*CBC, leukocytosis
	*CRP elevated		*CRP elevated

Neil.m.young: Text replacement - "0 mg" to "0mg"

2016-07-20T02:35:30Z

Text replacement - "0 mg" to "0mg"

← Older revision		Revision as of 02:35, 20 July 2016
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	==Management==		==Management==
	*All treatments controversial and of questionable efficacy		*All treatments controversial and of questionable efficacy
	*[[Methylprednisolone]] 500-~~1000 mg~~ qd for 3 days<ref>Rice AJ, Wells AU, Bouros D, Du Bois RM, Hansell DM, Polychronopoulos V, et al. Terminal diffuse alveolar damage in relation to interstitial pneumonias. An autopsy study. Am J Clin Pathol 2003;119:709-14.</ref><ref>Saydain G, Islam A, Afessa B, Ryu JH, Scott JP, Peters SG. Outcome of patients with idiopathic pulmonary fibrosis admitted to the intensive care unit. Am J Respir Crit Care Med 2002;166:839-42.</ref>		*[[Methylprednisolone]] 500-1000mg qd for 3 days<ref>Rice AJ, Wells AU, Bouros D, Du Bois RM, Hansell DM, Polychronopoulos V, et al. Terminal diffuse alveolar damage in relation to interstitial pneumonias. An autopsy study. Am J Clin Pathol 2003;119:709-14.</ref><ref>Saydain G, Islam A, Afessa B, Ryu JH, Scott JP, Peters SG. Outcome of patients with idiopathic pulmonary fibrosis admitted to the intensive care unit. Am J Respir Crit Care Med 2002;166:839-42.</ref>
	*[[Heparin]] drip		*[[Heparin]] drip
	**Alveolar injury predisposes to prothrombotic state		**Alveolar injury predisposes to prothrombotic state