CT predictors of mortality in pathology confirmed ARDS

Chung, Jonathan H.; Kradin, Richard L.; Greene, Reginald E.; Shepard, Jo-Anne O.; Digumarthy, Subba R.

doi:10.1007/s00330-010-1979-0

Cited by 52 publications

(51 citation statements)

References 35 publications

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“…In line with our findings, Chung et al 6 found that parenchymal involvement of Ͼ80% shown on CT scans of subjects with ARDS was associated with high mortality. The study by Chung et al 6 defining CT predictors of mortality in subjects with ARDS also demonstrated that a ratio of right to left atrial diameter of Ͼ1 was significantly more common in non-survivors than in survivors.…”

Section: Discussionsupporting

confidence: 93%

“…16 The percentage of lung involvement was estimated qualitatively to the nearest 10th percentile (eg, 10%, 20%) by evaluating the axial and coronal CT images. 6 The radiologist suggested a specific etiology when a characteristic pattern was identified on CT scans.…”

Section: Evaluation Of Lung Parenchymamentioning

confidence: 99%

“…2 Whereas a conventional chest x-ray is mandatory for the diagnosis of ARDS, computed tomography (CT) is not required to satisfy the diagnostic criteria outlined in the Berlin definition. However, CT scans in patients with ARDS are often performed for the following indications: confirmation of diagnosis, 3 assessment of recruitability, 4 identification of a pulmonary or extrapulmonary cause, 5 prediction of prognosis, [6][7][8] and follow-up. 9 Many ARDS centers, including our department, routinely perform CT scans in patients with ARDS, believing that this may yield clinically relevant information.…”

Section: Introductionmentioning

confidence: 99%

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Value of Computed Tomography of the Chest in Subjects With ARDS: A Retrospective Observational Study

et al. 2015

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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.

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Section: Discussionsupporting

confidence: 93%

Section: Evaluation Of Lung Parenchymamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Value of Computed Tomography of the Chest in Subjects With ARDS: A Retrospective Observational Study

et al. 2015

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“…19 The presence of traction bronchiectasis was also found to be a predictor of poor outcome in another study, along with disease affecting over 80% of the lungs, and signs of elevated right heart pressure (pulmonary artery dilatation and an enlarged right ventricle). 20 This study also suggested that patients who have a pure consolidative pattern of disease in the early stages have a better chance of survival. The implication of this observation is that, because consolidation is not a marker of fibrotic change, there is a more favorable outcome for this group of patients, thus indirectly supporting the finding that early fibrosis in ARDS is associated with a higher risk of death.…”

Section: Ct As a Means Of Prognosticating In Ardsmentioning

confidence: 76%

Imaging of Acute Respiratory Distress Syndrome

2012

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Chest radiography and computed tomography (CT) have a crucial role to play in the diagnosis and management of acute respiratory distress syndrome (ARDS). The identification of pulmonary opacification is a requirement for the definition of ARDS on the chest radiograph, while CT has a role to play, not only in the diagnosis of ARDS, but also in the identification of complications. This paper reviews the radiological appearances of ARDS that have been documented for some time, and also more recent research that has identified a role for CT in directing ventilation and in prognostication.

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“…Despite this fact, the development of bronchiectasis, in particular, is a poor prognostic sign. In the study by Chung and colleagues, 32 the development of varcoid bronchiectasis was associated with higher mortality, seen in 43% of patients who died but only 7% of survivors.…”

Section: The Subacute To Chronic Appearance Of Acute Lung Injurymentioning

confidence: 93%