Computed tomography-based risk estimation on acute lung injury/acute respiratory distress syndrome after blunt thoracic trauma

U Gottschaldt, P Merkel, AP Reske, D Schreiter, M Seiwerts, F Pfeifer and AW Reske

University Hospital Leipzig, Germany

from 26th International Symposium on Intensive Care and Emergency Medicine
Brussels, Belgium. 21–24 March 2006

Critical Care 2006, 10(Suppl 1):P10doi:10.1186/cc4357

The electronic version of this abstract is the complete one and can be found online at: http://ccforum.com/supplements/10/S1

Published:

21 March 2006

Objective

Computed tomography (CT) is used in the diagnostic management of polytraumatized patients. Multiple trauma and pulmonary contusion are typical triggers of post-traumatic acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) [1]. Therefore, an early predictor of post-traumatic ALI/ARDS would be valuable. In this study we tested whether the mass of nonaerated lung tissue (Mnon) in admission CT could predict post-traumatic ALI/ARDS.

Methods

The Mnon of 54 polytraumatized patients with pulmonary contusion was analyzed as previously described [2]. We studied the association of Mnon with physiologic variables and injury descriptors such as PaO₂/FiO₂ratio, injury severity score (ISS) and thoracic trauma severity score (TTSS) [3] recorded on admission. To evaluate Mnon as a predictor of ALI/ARDS we used a receiver operator characteristic (ROC) curve.

Results

Patients developing post-traumatic ALI/ARDS had significantly larger Mnon and significantly higher ISS and TTSS values. Literature data suggest a higher incidence of ALI/ARDS with a contusioned lung volume >20% [4]. Our results, however, indicate a higher risk of ALI/ARDS already with a Mnon of around 10%. The Mnon predicting ALI/ARDS with the highest sensitivity (81%) and specificity (87%) was 9.8%. The area under the ROC curve was 0.89 (confidence interval 0.79–0.99).

Conclusion

The mass of nonaerated lung tissue on admission CT can help to predict the development of ALI/ARDS. It may thereby help to implement appropriate therapeutic options such as lung protective ventilation. The clinical use of our technique, however, is limited by the time-consuming CT analysis.

References

Ware LB, Matthay MA:
N Engl J Med. 2000, 432:1334-1349. Publisher Full Text
Schreiter D, et al.:
Crit Care Med. 2004, 32:968-975. PubMed Abstract | Publisher Full Text
Pape HC, et al.:
J Trauma. 2000, 49:496-504. PubMed Abstract | Publisher Full Text
Miller PR, et al.:
J Trauma. 2001, 51:223-230. PubMed Abstract | Publisher Full Text

This article is part of the supplement: 26th International Symposium on Intensive Care and Emergency Medicine