Interstitial lung disease (ILD) comprises a diverse group of disorders characterized by varying degrees of fibrosis and inflammation within the lung parenchyma. Patients with ILD are at increased risk for acute respiratory decompensation, particularly in the intensive care unit (ICU) setting. Managing these patients is challenging due to the complexities of their chronic condition and the potential for life-threatening complications such as pneumothorax. Clinicians must balance the need for prompt diagnosis and treatment with the risks associated with invasive procedures [1, 2] [Ref: Algorithm 89.1].