Log in | Register

Early lung ultrasonography predicts the occurrence of acute respiratory distress syndrome in blunt trauma patients

Damien Leblanc| Clément Bouvet| Franck Degiovanni| Cosmina Nedelcu| Guillaume Bouhours| Emmanuel Rineau| Catherine Ridereau-Zins| Laurent Beydon| Sigismond Lasocki
Original
Volume 40, Issue 10 / October , 2014

Pages 1468 - 1474

Abstract

Purpose

Extent of lung contusion on initial computed tomography (CT) scan predicts the occurrence of acute respiratory distress syndrome (ARDS) in blunt chest trauma patients. We hypothesized that lung ultrasonography (LUS) on admission could also predict subsequent ARDS.

Methods

Forty-five blunt trauma patients were prospectively studied. Clinical examination, chest radiography, and LUS were performed on arrival at the emergency room. Lung contusion extent was quantified using a LUS score and compared to CT scan measurements. The ability of the LUS score to predict ARDS was tested using the area under the receiver operating characteristic curve (AUC-ROC). The diagnostic accuracy of LUS was compared to that of combined clinical examination and chest radiography for pneumothorax, lung contusion, and hemothorax, with thoracic CT scan as reference.

Results

Lung contusion extent assessed by LUS on admission was predictive of the occurrence of ARDS within 72 h (AUC-ROC = 0.78 [95 % CI 0.64–0.92]). The extent of lung contusion on LUS correlated well with CT scan measurements (Spearman’s coefficient = 0.82). A LUS score of 6 out of 16 was the best threshold to predict ARDS, with a 58 % [95 % CI 36–77] sensitivity and a 96 % [95 % CI 76–100] specificity. The diagnostic accuracy of LUS was higher than that of combined clinical examination and chest radiography: (AUC-ROC) 0.81 [95 % CI 0.50–1.00] vs. 0.74 [0.48–1.00] (p = 0.24) for pneumothorax, 0.88 [0.76–1.00] vs. 0.69 [0.47–0.92] (p < 0.05) for lung contusion, and 0.84 [0.59–1.00] vs. 0.73 [0.51–0.94] (p < 0.05) for hemothorax.

Conclusions

LUS on admission identifies patients at risk of developing ARDS after blunt trauma. In addition, LUS allows rapid and accurate diagnosis of common traumatic thoracic injuries.

Keywords

References

  1. Allen GS, Coates NE (1996) Pulmonary contusion: a collective review. Am Surg 62:895–900
    • View reference on PubMed
  2. Ciesla DJ, Moore EE, Johnson JL, Burch JM, Cothren CC, Sauaia A (2005) The role of the lung in postinjury multiple organ failure. Surgery 138:749–757
    • View reference on PubMed
    • View reference on publisher's website
  3. Raghavendran K, Notter RH, Davidson BA, Helinski JD, Kunkel SL, Knight PR (2009) Lung contusion: inflammatory mechanisms and interaction with other injuries. Shock 32:122–130
    • View reference on PubMed
    • View reference on publisher's website
  4. Becher RD, Colonna AL, Enniss TM, Weaver AA, Crane DK, Martin RS, Mowery NT, Miller PR, Stitzel JD, Hoth JJ (2012) An innovative approach to predict the development of adult respiratory distress syndrome in patients with blunt trauma. J Trauma Acute Care Surg 73:1229–1235
    • View reference on PubMed
    • View reference on publisher's website
  5. Miller PR, Croce MA, Bee TK, Qaisi WG, Smith CP, Collins GL, Fabian TC (2001) ARDS after pulmonary contusion: accurate measurement of contusion volume identifies high-risk patients. J Trauma 51:223–230
    • View reference on PubMed
    • View reference on publisher's website
  6. Strumwasser A, Chu E, Yeung L, Miraflor E, Sadjadi J, Victorino GP (2011) A novel CT volume index score correlates with outcomes in polytrauma patients with pulmonary contusion. J Surg Res 170:280–285
    • View reference on PubMed
    • View reference on publisher's website
  7. Wang S, Ruan Z, Zhang J, Jin W (2011) The value of pulmonary contusion volume measurement with three-dimensional computed tomography in predicting acute respiratory distress syndrome development. Ann Thorac Surg 92:1977–1983
    • View reference on PubMed
    • View reference on publisher's website
  8. Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T (2012) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 38:577–591
  9. Xirouchaki N, Kondili E, Prinianakis G, Malliotakis P, Georgopoulos D (2014) Impact of lung ultrasound on clinical decision making in critically ill patients. Intensive Care Med 40:57–65
  10. Mayo PH (2013) Critical care ultrasonography: the Italian approach. Intensive Care Med 39:1849–1850
  11. Volpicelli G, Lamorte A, Tullio M, Cardinale L, Giraudo M, Stefanone V, Boero E, Nazerian P, Pozzi R, Frascisco MF (2013) Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department. Intensive Care Med 39:1290–1298
  12. Hyacinthe AC, Broux C, Francony G, Genty C, Bouzat P, Jacquot C, Albaladejo P, Ferretti GR, Bosson JL, Payen JF (2012) Diagnostic accuracy of ultrasonography in the acute assessment of common thoracic lesions after trauma. Chest 141:1177–1183
    • View reference on PubMed
    • View reference on publisher's website
  13. Rocco M, Carbone I, Morelli A, Bertoletti L, Rossi S, Vitale M, Montini L, Passariello R, Pietropaoli P (2008) Diagnostic accuracy of bedside ultrasonography in the ICU: feasibility of detecting pulmonary effusion and lung contusion in patients on respiratory support after severe blunt thoracic trauma. Acta Anaesthesiol Scand 52:776–784
    • View reference on PubMed
    • View reference on publisher's website
  14. Bouhemad B, Zhang M, Lu Q, Rouby JJ (2007) Clinical review: bedside lung ultrasound in critical care practice. Crit Care 11:205
    • View reference on PubMed
    • View reference on publisher's website
  15. Wolfman NT, Myers WS, Glauser SJ, Meredith JW, Chen MY (1998) Validity of CT classification on management of occult pneumothorax: a prospective study. AJR Am J Roentgenol 171:1317–1320
    • View reference on PubMed
    • View reference on publisher's website
  16. Hazlinger M, Ctvrtlik F, Langova K, Herman M (2014) Quantification of pleural effusion on CT by simple measurement. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 158:107–111
    • View reference on PubMed
  17. Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, Brochard L, Brower R, Esteban A, Gattinoni L, Rhodes A, Slutsky AS, Vincent JL, Rubenfeld GD, Thompson BT, Ranieri VM (2012) The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med 38:1573–1582
  18. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin definition. JAMA 307:2526–2533
    • View reference on PubMed
  19. Youden WJ (1950) Index for rating diagnostic tests. Cancer 3:32–35
    • View reference on PubMed
    • View reference on publisher's website
  20. Soldati G, Testa A, Sher S, Pignataro G, La Sala M, Silveri NG (2008) Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department. Chest 133:204–211
    • View reference on PubMed
    • View reference on publisher's website
  21. Soldati G, Testa A, Silva FR, Carbone L, Portale G, Silveri NG (2006) Chest ultrasonography in lung contusion. Chest 130:533–538
    • View reference on PubMed
    • View reference on publisher's website
  22. Ciesla DJ, Moore EE, Johnson JL, Cothren CC, Banerjee A, Burch JM, Sauaia A (2006) Decreased progression of postinjury lung dysfunction to the acute respiratory distress syndrome and multiple organ failure. Surgery 140:640–648
    • View reference on PubMed
    • View reference on publisher's website
  23. Lellouche F, Lipes J (2013) Prophylactic protective ventilation: lower tidal volumes for all critically ill patients? Intensive Care Med 39:6–15
  24. Brooks A, Davies B, Smethhurst M, Connolly J (2004) Emergency ultrasound in the acute assessment of haemothorax. Emerg Med J 21:44–46
    • View reference on PubMed
    • View reference on publisher's website
  25. Zhang M, Liu ZH, Yang JX, Gan JX, Xu SW, You XD, Jiang GY (2006) Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma. Crit Care 10:R112
    • View reference on PubMed
    • View reference on publisher's website
  26. Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ (2004) Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 100:9–15
    • View reference on PubMed
    • View reference on publisher's website
  27. Nandipati KC, Allamaneni S, Kakarla R, Wong A, Richards N, Satterfield J, Turner JW, Sung KJ (2011) Extended focused assessment with sonography for trauma (EFAST) in the diagnosis of pneumothorax: experience at a community based level I trauma center. Injury 42:511–514
    • View reference on PubMed
    • View reference on publisher's website

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement