Detection of fibroproliferation by chest high-resolution CT scan in resolving ARDS.
BACKGROUND
In ARDS, the extent of fibroproliferative activity on chest high-resolution CT (HRCT) scan has been reported to correlate with poorer short-term outcomes and pulmonary-associated quality of life. However, clinical factors associated with HRCT scan fibroproliferation are incompletely characterized. We questioned if lung compliance assessed at the bedside would be associated with fibroproliferation on HRCT scans obtained during the resolution phase of ARDS.


METHODS
We used data from a published randomized, controlled clinical trial in ARDS. All patients were cared for using a low tidal volume strategy. Demographic data and ventilator parameters were examined in association with radiologic scores from chest HRCT scans obtained 14 days after diagnosis.


RESULTS
Data from 82 patients with ARDS were analyzed. Average static respiratory compliance over the first 14 days after diagnosis was inversely associated with chest HRCT scan reticulation (ρ = -0.46); this relationship persisted in multivariable analysis including APACHE (Acute Physiology and Chronic Health Evaluation) II scores, initial Pao2/Fio2, pneumonia diagnosis, and ventilator days. Average static respiratory compliance was also lower among patients with bronchiectasis at day 14 (P = .007). Initial static respiratory compliance obtained within the first day after ARDS diagnosis was correlated inversely with the presence of HRCT scan reticulation (ρ = -0.38) and was lower among patients who demonstrated bronchiectasis on the day 14 HRCT scan (P = .008).


CONCLUSIONS
In patients with ARDS, diminished lung compliance measured bedside was associated with radiologic fibroproliferation 14 days post diagnosis. Establishing factors that predispose to development of excessive fibroproliferation with subsequent confirmation by chest HRCT scan represents a promising strategy to identify patients with ARDS at risk for poorer clinical outcomes.
From the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO. Electronic address: ellen.burnham@ucdenver.edu.
Ellen L
EL
Burnham
Division of Pulmonary and Critical Care Medicine, University of Michigan School of Medicine, Ann Arbor, MI.
Robert C
RC
Hyzy
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT.
Robert
R
Paine
Department of Medicine, and the Department of Radiology, University of Michigan School of Medicine, Ann Arbor, MI.
Aine M
AM
Kelly
Department of Medicine, and the Department of Radiology, University of Michigan School of Medicine, Ann Arbor, MI.
Leslie E
LE
Quint
Department of RadiologyNational Jewish Health, Denver, CO.
David
D
Lynch
Department of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO; Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO.
Douglas
D
Curran-Everett
From the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO.
Marc
M
Moss
Division of Pulmonary and Critical Care Medicine, University of Michigan School of Medicine, Ann Arbor, MI.
Theodore J
TJ
Standiford
D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000209:etiology; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed