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  • Poster presentation
  • Open Access

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

  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Critical Care200610 (Suppl 1) :P10

https://doi.org/10.1186/cc4357

  • Published:

Keywords

  • Receiver Operator Characteristic
  • Receiver Operator Characteristic Curve
  • Acute Lung Injury
  • Acute Respiratory Distress Syndrome
  • Injury Severity Score

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/FiO2 ratio, 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.

Authors’ Affiliations

(1)
University Hospital Leipzig, Germany

References

  1. Ware LB, Matthay MA: N Engl J Med. 2000, 432: 1334-1349. 10.1056/NEJM200005043421806View ArticleGoogle Scholar
  2. Schreiter D, et al.: Crit Care Med. 2004, 32: 968-975. 10.1097/01.CCM.0000120050.85798.38View ArticlePubMedGoogle Scholar
  3. Pape HC, et al.: J Trauma. 2000, 49: 496-504. 10.1097/00005373-200009000-00018View ArticlePubMedGoogle Scholar
  4. Miller PR, et al.: J Trauma. 2001, 51: 223-230. 10.1097/00005373-200108000-00003View ArticlePubMedGoogle Scholar

Copyright

© BioMed Central Ltd 2006

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