ICU Management of the Patient With Fibrotic Interstitial Lung Disease
Bibliographic record
Abstract
With the advent of new therapies and improvements in supportive care, survivorship in patients with interstitial lung disease (ILD) is increasing. However, this increase in number of patients living with ILD has resulted in an increase in the number of patients admitted to hospitals with acute exacerbations of ILD, most commonly manifested as advanced hypoxemic respiratory failure. In addition, patients with ILD may be admitted to the hospital as their first manifestation of ILD or progression of an ILD of yet to be diagnosed cause. All of these presentations carry significant risk of severe respiratory failure requiring admission to an ICU. It is therefore necessary for the critical care practitioner to have an approach to the patient with ILD being admitted to the ICU. This review summarizes an approach to the evaluation and management of patients presenting to the ICU through a discussion of: (1) diagnosis of acute exacerbation in patients with previously diagnosed ILD; (2) diagnosis of patients presenting with ILD of unknown cause; (3) treatment of both acute exacerbations and underlying causes of ILD; (4) supportive ICU care for advanced respiratory failure due to ILD; and (5) outcomes of patients with ILD and severe respiratory failure in the ICU. In addition, we offer suggested approaches to determining the cause of respiratory deterioration in patients with ILD and deciding which advanced respiratory support devices are reasonable in managing ILD patients who have progressive respiratory failure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".