Dataset Information

Is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? A population-based cohort study.

ABSTRACT:

Purpose

The definition of acute respiratory distress syndrome (ARDS) has often been modified with Berlin criteria being the most recent. ARDS is divided into three categories based on the degree of hypoxemia using PaO₂/FiO₂ ratio. Radiological findings are standardized with bilateral diffuse pulmonary infiltrates present on chest imaging. This study investigated whether chest imaging is relevant in diagnosing ARDS in polytrauma patients.

Methods

The 5-year prospective study included consecutive trauma patients admitted to a Level-1 Trauma Center ICU. Demographics, ISS, physiologic parameters, resuscitation parameters, and ARDS data were prospectively collected. Acute hypoxic respiratory failure (AHRF) was categorized as Berlin criteria without bilateral diffuse pulmonary infiltrates on imaging. Data are presented as median (IQR), p?Results267 patients were included. Median age was 45 (26-59) years, 199 (75%) males, ISS was 29 (22-35), 258 (97%) patients had blunt injuries. Thirty-five (13%) patients died. 192 (72%) patients developed AHRF. AHRF patients were older, more often male, had higher ISS, needed more crystalloids and blood products than patients without AHRF. They developed more pulmonary complications, stayed longer on the ventilator, in ICU and in hospital, and died more often. Fifteen (6%) patients developed ARDS. There was no difference in outcome between ARDS and AHRF patients.

Conclusions

Many patients developed AHRF and only a few ARDS. Patients with similar hypoxemia without bilateral diffuse pulmonary infiltrates had comparable outcome as ARDS patients. Chest imaging did not influence the outcome. Large-scale multicenter validation of ARDS criteria is warranted to investigate whether diffuse bilateral pulmonary infiltrates on chest imaging could be omitted as a mandatory part of the definition of ARDS in polytrauma patients.

SUBMITTER: van Wessem KJP

PROVIDER: S-EPMC7689641 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

Is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? A population-based cohort study.

van Wessem Karlijn Julia Patricia KJP Leenen Luke Petrus Hendrikus LPH

European journal of trauma and emergency surgery : official publication of the European Trauma Society 20190810 6

<h4>Purpose</h4>The definition of acute respiratory distress syndrome (ARDS) has often been modified with Berlin criteria being the most recent. ARDS is divided into three categories based on the degree of hypoxemia using PaO<sub>2</sub>/FiO<sub>2</sub> ratio. Radiological findings are standardized with bilateral diffuse pulmonary infiltrates present on chest imaging. This study investigated whether chest imaging is relevant in diagnosing ARDS in polytrauma patients.<h4>Methods</h4>The 5-year pr ...[more]

PMID: 31401658

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Project description:BACKGROUND: The acute respiratory distress syndrome (ARDS) is a common, devastating complication of critical illness that is characterized by pulmonary injury and inflammation. The clinical diagnosis may be improved by means of objective biological markers. Electronic nose (eNose) technology can rapidly and non-invasively provide breath prints, which are profiles of volatile metabolites in the exhaled breath. We hypothesized that breath prints could facilitate accurate diagnosis of ARDS in intubated and ventilated intensive care unit (ICU) patients. METHODS: Prospective single-center cohort study with training and temporal external validation cohort. Breath of newly intubated and mechanically ventilated ICU-patients was analyzed using an electronic nose within 24 hours after admission. ARDS was diagnosed and classified by the Berlin clinical consensus definition. The eNose was trained to recognize ARDS in a training cohort and the diagnostic performance was evaluated in a temporal external validation cohort. RESULTS: In the training cohort (40 patients with ARDS versus 66 controls) the diagnostic model for ARDS showed a moderate discrimination, with an area under the receiver-operator characteristic curve (AUC-ROC) of 0.72 (95%-confidence interval (CI): 0.63-0.82). In the external validation cohort (18 patients with ARDS versus 26 controls) the AUC-ROC was 0.71 [95%-CI: 0.54 - 0.87]. Restricting discrimination to patients with moderate or severe ARDS versus controls resulted in an AUC-ROC of 0.80 [95%-CI: 0.70 - 0.90]. The exhaled breath profile from patients with cardiopulmonary edema and pneumonia was different from that of patients with moderate/severe ARDS. CONCLUSIONS: An electronic nose can rapidly and non-invasively discriminate between patients with and without ARDS with modest accuracy. Diagnostic accuracy increased when only moderate and severe ARDS patients were considered. This implicates that breath analysis may allow for rapid, bedside detection of ARDS, especially if our findings are reproduced using continuous exhaled breath profiling. TRIAL REGISTRATION: NTR2750, registered 11 February 2011.

Dataset Information

Is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? A population-based cohort study.

Purpose

Methods

Conclusions

Publications

Is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? A population-based cohort study.

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