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


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.


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.


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).


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.


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Gottschaldt, U., Merkel, P., Reske, A. et al. Computed tomography-based risk estimation on acute lung injury/acute respiratory distress syndrome after blunt thoracic trauma. Crit Care 10 (Suppl 1), P10 (2006).

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