The value of pulmonary contusion volume measurement with three-dimensional computed tomography in predicting acute respiratory distress syndrome development

Abstract

Background: This study reports the value of accurate pulmonary contusion (PC) volume measurement with 3-dimensional computed tomography (CT) in predicting acute respiratory distress syndrome (ARDS) development.

Methods: The study enrolled all patients who were diagnosed with PC on admission by CT and had a chest Abbreviated Injury Score (AIS) exceeding 2 between January 1, 2010, and October 31, 2010. PC volume was measured from 3-dimensional reconstructions of admission chest CTs and expressed as a percentage of total lung volume. Admission data were prospectively collected. The independent predictor of ARDS development was established. The accuracy and value of the predictors were analyzed, and the influence of PC volume percentage on clinical outcomes was demonstrated.

Results: The average PC volume percentage was 21.86% ± 13.90% (range, 5.6% to 61.0%), which was inconsistently correlated with the admission partial pressure of oxygen/fraction of inspired oxygen ratio (R(2) = 0.083). ARDS was diagnosed in 26 patients (43.3%) and pneumonia in 21 (35.0%). The admission partial pressure of oxygen/fraction of inspired oxygen ratio (p = 0.003) and PC volume percentage (p = 0.01) were independent predictive factors of ARDS development. Patients with a PC volume percentage exceeding the best cutoff of 21.5% were defined as the severe PC group. The partial pressure of oxygen/fraction of inspired oxygen ratio, the needed maximal positive end-expiratory pressure level, and ARDS incidence between the severe group and the general group was significantly different (p <.05).

Conclusions: Pulmonary contusion volume measured using 3-dimensional CT is feasible in emergency departments and helpful to identify patients at high-risk for ARDS.