NEW onset interstitial lung disease has intensive care mortality matching established disease in severe respiratory failure.
In this retrospective observational cohort, investigators reviewed 80 patients with interstitial lung disease admitted consecutively to an adult intensive care unit between 2009 and 2023 with severe acute respiratory failure. New onset interstitial lung disease was defined as symptom duration shorter than six months before admission, while established disease reflected longer standing symptoms. Overall ICU mortality was 50%, with similar proportions of connective tissue disease related interstitial lung disease, idiopathic interstitial pneumonias and exposure related disease across the cohort.
Outcomes In New Onset Interstitial Lung Disease
Among 33 patients with new onset interstitial lung disease and 47 with established disease, ICU mortality was comparable at 48 versus 51%. New onset cases experienced a longer median stay in the intensive care unit and longer time on invasive mechanical ventilation, although these differences did not reach statistical significance. One year survival was numerically higher in the new onset group at 51 versus 36%, based on Kaplan Meier analysis censored at twelve months from ICU admission.
Risk Profile and Critical Care Interventions
Non survivors in the intensive care unit were older and had higher admission APACHE and SOFA scores than survivors, indicating greater acute severity and organ dysfunction at presentation. They also had lower BMI and were more likely to receive invasive mechanical ventilation during admission. Across the full cohort, 64 patients required invasive mechanical ventilation, 23 received extracorporeal membrane oxygenation therapy and 30 were treated with two or more immunosuppressive medications, reflecting the intensity of organ support required in interstitial lung disease related severe acute respiratory failure.
Implications For ICU Decision Making
These findings suggest that a new diagnosis of interstitial lung disease should not automatically preclude intensive care admission when severe acute respiratory failure develops. Instead, decisions may be better guided by age, physiological reserve, severity scores and anticipated reversibility of respiratory failure. For pulmonologists, rheumatologists and intensivists, this study supports multidisciplinary discussion and early referral to teams that can provide advanced organ support, while also reinforcing the need for realistic goals of care in this high-risk population.
Reference: Soo I et al. Patients with new-onset interstitial lung disease (ILD) do not have higher mortality than those with established ILD when admitted to intensive care with severe acute respiratory failure (SARF). Thorax. 2025;80(Suppl 2):A107.
