Q: All of the following should be considered as a comfort measure in last stage of idiopathic Pulmonary Fibrosis (IPF) except?

A) Facial cooling 
B) Opiates
C) Benzodiazepines, 
D) Non-Invasive ventilation (NIPPV)
E) Palliation of cough symptoms


Answer: D

Unfortunately in terminal IPF, invasive or non-invasive ventilation is of not much help. Non-invasive mechanical ventilation is of limited help. If comfort measures are in process, NIPPV should be used only in case to case basis, with clear explanation to patient and family that though it may improve oxygenation but may not help in time to death. Surprisingly, most patients understands and agree on against use of NIPPV.

NIPPV though may help in patients where there is a hope in relief and resolution of acute exacerbation of IPF or resolution of underlying pneumonia.