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Original Research: Critical Care |

Detection of Fibroproliferation by Chest High-Resolution CT Scan in Resolving ARDSHigh-Resolution CT Scan Fibroproliferation in ARDS

Ellen L. Burnham, MD; Robert C. Hyzy, MD, FCCP; Robert Paine, III, MD; Aine M. Kelly, MD; Leslie E. Quint, MD; David Lynch, MB; Douglas Curran-Everett, PhD; Marc Moss, MD; Theodore J. Standiford, MD
Author and Funding Information

From the Division of Pulmonary Sciences and Critical Care Medicine (Drs Burnham and Moss), Department of Medicine, University of Colorado School of Medicine, Aurora, CO; the Division of Pulmonary and Critical Care Medicine (Drs Hyzy and Standiford), Department of Medicine, and the Department of Radiology (Drs Kelly and Quint), University of Michigan School of Medicine, Ann Arbor, MI; the Division of Pulmonary and Critical Care Medicine (Dr Paine), Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT; Department of Radiology (Dr Lynch) and the Department of Biostatistics and Bioinformatics (Dr Curran-Everett), National Jewish Health, Denver, CO; and the Department of Biostatistics and Informatics (Dr Curran-Everett), University of Colorado School of Public Health, Aurora, CO.

CORRESPONDENCE TO: Ellen L. Burnham, MD, University of Colorado School of Medicine, Anschutz Medical Campus, 12700 E. 19th Ave, C272, Aurora, CO 80045; e-mail: ellen.burnham@ucdenver.edu


FOR EDITORIAL COMMENT SEE PAGE 1140

Some of this work has been previously reported as an abstract at the American Thoracic Society International Meeting, May 19, 2013, Philadelphia, PA.

FUNDING/SUPPORT: This work was supported by the National Institutes of Health/National Heart, Lung, and Blood Institute [Grant P50 HL074024].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(5):1196-1204. doi:10.1378/chest.13-2708
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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.

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