Acute respiratory distress syndrome related to influenza A H1N1 infection: Correlation of pulmonary computed tomography findings to extracorporeal membrane oxygenation treatment and clinical outcome

• Published in: Journal of critical care Vol. 27; no. 6; pp. 602 - 608
• Main Authors: Lazoura, O., PhD, Parthipun, A.A., FRCR, Roberton, B.J., FRCR, Downey, K., FRCR, Finney, S., PhD, FRCA, Padley, S., FRCR
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2012; Elsevier Limited
• Subjects: Adult; Age; Consolidation; Critical Care; Disease Progression; ECMO; Extracorporeal Membrane Oxygenation - methods; Female; Humans; Infections; Influenza; Influenza A (H1N1); Influenza A Virus, H1N1 Subtype; Influenza, Human - complications; Influenza, Human - epidemiology; Intensive Care Units; Lung disease score; Lung diseases; Lungs; Male; Medical imaging; Middle Aged; Obesity; Patients; Respiration, Artificial; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - diagnostic imaging; Respiratory Distress Syndrome, Adult - epidemiology; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - therapy; Retrospective Studies; Severity of Illness Index; Studies; Swine flu; Tomography, X-Ray Computed; Treatment Outcome; Ventilation; ECMO; CT; Lung disease score; Swine flu; Influenza A (H1N1)
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2012.04.009

Abstract Purpose The aim of the present study was to correlate computed tomography appearances with clinical severity and outcome using a total lung disease (TLD) score in patients with acute respiratory distress syndrome (ARDS) related to influenza A H1N1 infection. Materials and Methods Chest computed tomographic scans of 33 patients admitted in the intensive care unit with ARDS related to influenza A H1N1 were retrospectively reviewed. Total lung disease was calculated from the combined extent of consolidation (TLC) and ground glass (TLGG) in the anterior, middle, and posterior segments of the lungs at 3 different levels (apex, hila, and base) using the method described by Goodman et al ( Radiology . 213:545-552;1999). Total lung disease, TLC, and TLGG were statistically correlated with demographic characteristics, requirement for extracorporeal membrane oxygenation (ECMO) treatment, and patient outcome. Results Total lung disease is higher in patients who require ECMO treatment ( P = .016). It is significantly higher ( P = .003) in the posterior segments and significantly lower ( P = .0001) in the anterior segments compared with TLGG. Total consolidation significantly increases ( P = .0001), whereas TLGG significantly decreases ( P = .0001) from the anterior toward the posterior segments. There is also a significant increase in TLD ( P = .0001), TLC ( P = .0001), and TLGG ( P = .004) from the apices to the lung bases. There is a negative correlation between TLD and age ( P = .01), and TLGG and body mass index ( P = .014). Total consolidation is higher ( P = .013) and TLGG is lower ( P = .012) in patients with a body mass index greater than 30 kg/m2. Conclusion A greater extent of air-space disease in ARDS related to influenza A H1N1 infection is associated with progression to ECMO treatment and, therefore, clinical severity. The extent of total air-space disease is greater in younger patients, and obesity is related to a more extensive consolidation.