Open AccessA quantitative CT parameter for the assessment of pulmonary oedema in patients with acute respiratory distress syndrome
Author(s) -
Patrick Leiser,
Thomas Kirschning,
Christel Weiß,
Michael Hagmann,
Jochen J. Schoettler,
Franz-Simon Centner,
Holger Haubenreisser,
Philipp Riffel,
S. Janssen,
Claudia Henzler,
Thomas Henzler,
Stefan O. Schoenberg,
Daniel Overhoff
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0241590
Subject(s) - medicine , ards , intensive care unit , lung , mechanical ventilation , cardiology , respiratory distress , intensive care , ventilation (architecture) , lung volumes , saps ii , anesthesia , apache ii , intensive care medicine , mechanical engineering , engineering
Objectives The aim of this study was to establish quantitative CT (qCT) parameters for pathophysiological understanding and clinical use in patients with acute respiratory distress syndrome (ARDS). The most promising parameter is introduced. Materials and methods 28 intubated patients with ARDS obtained a conventional CT scan in end-expiratory breathhold within the first 48 hours after admission to intensive care unit (ICU). Following manual segmentation, 137 volume- and lung weight-associated qCT parameters were correlated with 71 clinical parameters such as blood gases, applied ventilation pressures, pulse contour cardiac output measurements and established status and prognosis scores (SOFA, SAPS II). Results Of all examined qCT parameters, excess lung weight (ELW), i.e. the difference between a patient’s current lung weight and the virtual lung weight of a healthy person at the same height, displayed the most significant results. ELW correlated significantly with the amount of inflated lung tissue [%] (p<0.0001; r = -0.66) and was closely associated with the amount of extravascular lung water (EVLW) (p<0.0001; r = 0.72). More substantially than the oxygenation index (PaO 2 /FiO 2 ) or any other clinical parameter it correlated with the patients’ mean SOFA- (p<0.0001, r = 0.69) and SAPS II-Score (p = 0.0005, r = 0.62). Patients who did not survive intensive care treatment displayed higher values of ELW in the initial CT scans. Conclusions ELW could serve as a non-invasive method to quantify the amount of pulmonary oedema. It might serve as an early radiological marker of severity in patients with ARDS.