Oxygenation in acute exacerbations of interstitial lung disease: a nationwide survey

<bold>Rationale:</bold> Acute exacerbation of interstitial lung disease (AE-ILD) is a pathology leading to acute respiratory failure with a poor prognosis. Little is known about the optimal oxygenation strategy in this indication, especially since the development of high-flow nasal oxygen therapy (HFNO). We therefore conducted a nationwide survey among pulmonologists and intensive care unit (ICU) physicians to assess their real-life practices. <bold>Methods:</bold> Between January and June 2024, participants were questioned using an online survey (11 questions) regarding their non-invasive oxygenation strategy applied in the management of AE-ILD patients: face mask (FM), HFNO, continuous positive airway pressure (CPAP) or non-invasive ventilation (NIV). <bold>Results:</bold> The response rate was 119/270 (44.1%), 59.5% in ICU physicians and 40.5% respirologists. As the first-line strategy, HFNO was the most commonly used technique (59.5%), even outside the ICU ward (30.6%), while the NIV use was lesser (15.3%) and CPAP anecdotic (0.9%). NIV was mainly used as a second-line strategy (51.8%). 84.3% of the participants would be interested in taking part in a randomized clinical trial between different oxygenation strategies to assess their impact on the prognosis of patient in AE-ILD. <bold>Conclusion:</bold> Despite the lack of specific recommendations, HFNO has imposed itself as the first-line oxygenation strategy for the management of AE-ILD. If NIV, especially in association with HFNO, appears as the second-line treatment, a randomized clinical trial is needed and requested by clinicians to better assess the real impact of oxygenation strategies on patient outcome.