Marcel Simon1, Stephan Braune1, Azien Laqmani2, Maria Metschke1, Christoph Berliner2, Maria Kalsow1, Hans Klose3, Stefan Kluge4. 1. Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 2. Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 3. Department of Respiratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 4. Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. s.kluge@uke.de.
Abstract
BACKGROUND: The value of computed tomography (CT) of the chest in the management of patients with ARDS is poorly defined. The aim of this study was to assess the clinical utility of thoracic CT scans in subjects with ARDS using the Berlin definition. METHODS: This was a retrospective, observational study in a university hospital ARDS center on all subjects with ARDS in whom a CT scan of the chest was performed immediately before or during an ICU stay between January 1, 2007 and June 30, 2013. RESULTS: During the study period, a total of 1,781 thoracic CT scans were performed, of which 204 cases met inclusion criteria. The most common pathologic findings of the lung parenchyma were consolidations (94.1% of cases) and ground glass opacities (85.3%). Furthermore, CT scans showed pleural effusions (80.4%), mediastinal lymphadenopathy (66.7%), signs of right ventricular strain and pulmonary hypertension (53.9%), pericardial effusion (37.3%), emphysema of the chest wall (12.3%), pneumothorax (11.8%), emphysema of the mediastinum (7.4%), and pulmonary embolism (2.5%). Results of CT scans led to changes in management in 26.5% of cases. Mortality was significantly increased in subjects with involvement of lung parenchyma of >80% (P = .004). Intrahospital transport was associated with critical incidents in 8.3% of cases. CONCLUSIONS: Systematic evaluation of thoracic CT scans yielded information useful for making a diagnosis, predicting prognosis, and recognizing concomitant disorders requiring therapeutic interventions. Results obtained from CT scans led to changes in management in 26.5% of cases.
BACKGROUND: The value of computed tomography (CT) of the chest in the management of patients with ARDS is poorly defined. The aim of this study was to assess the clinical utility of thoracic CT scans in subjects with ARDS using the Berlin definition. METHODS: This was a retrospective, observational study in a university hospital ARDS center on all subjects with ARDS in whom a CT scan of the chest was performed immediately before or during an ICU stay between January 1, 2007 and June 30, 2013. RESULTS: During the study period, a total of 1,781 thoracic CT scans were performed, of which 204 cases met inclusion criteria. The most common pathologic findings of the lung parenchyma were consolidations (94.1% of cases) and ground glass opacities (85.3%). Furthermore, CT scans showed pleural effusions (80.4%), mediastinal lymphadenopathy (66.7%), signs of right ventricular strain and pulmonary hypertension (53.9%), pericardial effusion (37.3%), emphysema of the chest wall (12.3%), pneumothorax (11.8%), emphysema of the mediastinum (7.4%), and pulmonary embolism (2.5%). Results of CT scans led to changes in management in 26.5% of cases. Mortality was significantly increased in subjects with involvement of lung parenchyma of >80% (P = .004). Intrahospital transport was associated with critical incidents in 8.3% of cases. CONCLUSIONS: Systematic evaluation of thoracic CT scans yielded information useful for making a diagnosis, predicting prognosis, and recognizing concomitant disorders requiring therapeutic interventions. Results obtained from CT scans led to changes in management in 26.5% of cases.
Authors: Maurizio Cereda; Yi Xin; Alberto Goffi; Jacob Herrmann; David W Kaczka; Brian P Kavanagh; Gaetano Perchiazzi; Takeshi Yoshida; Rahim R Rizi Journal: Anesthesiology Date: 2019-09 Impact factor: 7.892