Idiopathic pulmonary fibrosis (IPF) is the commonest cause of interstitial lung disease. Till date there is no proven successful treatment. The prognosis is poor with a median survival of 3 years. Patients with IPF presented with acute respiratory failure are often referred to the intensive care unit for ventilatory support. Available data showed that outcome of these patients is very poor and mechanical ventilation is mostly futile. Patients and their families should be informed about the prognosis, outcome and overall outlook before making decision about ventilation and organ support. Available outcome data should be used to develop institutional and professional guidelines to help in making these difficult decisions.