Interstitial Lung Disease (Pulmonary Fibrosis, ILD)

Limited reserve, fast desaturation - Restrictive, poorly diffusing lungs mean little reserve; preoxygenate thoroughly and expect rapid desaturation with apnea.

Protective ventilation - Stiff lungs need higher pressures for a given volume; use low tidal volumes and limit plateau pressure to avoid barotrauma and pneumothorax.

Pulmonary hypertension and the right heart - Advanced disease brings pulmonary hypertension; avoid the hypoxia, hypercarbia, and acidosis that worsen it, and protect right-ventricular function.

Oxygen balance - High FiO2 may be needed but has been implicated in exacerbating some interstitial diseases; titrate to an adequate, not excessive, saturation.

High complication risk - Postoperative respiratory failure is common; plan analgesia for deep breathing and a careful, well-supported emergence.

Interstitial lung disease is a group of disorders that scar the lung interstitium, producing stiff, non-compliant lungs with reduced volumes (a restrictive pattern) and impaired diffusion.

The result is chronic hypoxemia, reduced pulmonary reserve, and, over time, pulmonary hypertension and right heart strain. Causes include idiopathic pulmonary fibrosis, connective-tissue disease, and exposures. These patients desaturate quickly and tolerate apnea poorly.