Q: All of the following are recommended to pursue during acute exacerbation of Idiopathic Pulmonary Fibrosis (AE-IPF) except?

A)  High-flow oxygen
B) Anti-acid/reflux treatment
C) Invasive mechanical ventilation
D) Broad spectrum antibiotic 
E) High dose steroids


Answer: C

 Invasive mechanial ventilation has an extremely high mortality in acute execerbation of IPF, and should be pursue only if patient or family insist despite full discussion and disclosure of potential harm, and high probaility of its failure as a salvage therapy.

Choice B may look surprising but reflux has been described as a possible cause of AE-IPF.


References:

1. Gaudry S, Vincent F, Rabbat A, et al. Invasive mechanical ventilation in patients with fibrosing interstitial pneumonia. J Thorac Cardiovasc Surg 2014; 147:47. 

2. Mallick S. Outcome of patients with idiopathic pulmonary fibrosis (IPF) ventilated in intensive care unit. Respir Med 2008; 102:1355. 

3. Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011; 183:788.

4. Lee JS, Collard HR, Anstrom KJ, et al. Anti-acid treatment and disease progression in idiopathic pulmonary fibrosis: an analysis of data from three randomised controlled trials. Lancet Respir Med 2013; 1:369.