Thoracic computed tomography in the critically ill patient

Lh, Roddy; Km, Unger; Wc, Miller

doi:10.1097/00003246-198107000-00003

Cited by 22 publications

(11 citation statements)

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“…Our results are consistent with previously reported experience with CT in intensive care patients (9,16,23,24), where percentages for therapeutic changes compared to chest radiography varied between 18% and 35%.…”

Section: Discussionsupporting

confidence: 93%

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CT and Chest Radiography in the Evaluation of Adult Respiratory Distress Syndrome

Tagliabue¹,

Casella²,

Zincone³

et al. 1994

Acta Radiol

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CT is seldom employed in adult respiratory distress syndrome (ARDS), mostly due to problems in transporting and monitoring these severely ill patients. We reviewed the findings of 74 ARDS patients who underwent chest CT. Lung opacities were bilateral in almost all patients and dependent in most cases (86%). The opacities were patchy (42%), homogeneous (23%), ground glass (8%) or mixed (27%). Opacities prevailed in basal regions (68%) compared to hilar and apical ones. Air bronchograms were frequently seen in areas of consolidation (89%). In contrast with previous reports, pleural effusion was a frequent finding (50%) that did not worsen prognosis. Often loculated pneumothorax (32%) was mostly anteromedial. Ineffective position of thoracostomy tubes was detected at CT in 13/ 20 patients. Pulmonary air cysts (30%), always multiple and mostly bilateral, were associated with a higher mortality (55%) than that of the whole study group (35%). Compared to chest radiographs, CT often yielded additional information (66%), with direct influence on patient treatment in 22% of cases.

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Section: Discussionsupporting

confidence: 93%

“…The presence of pulmonary air cysts is a sign of interstitial pulmonary emphysema (23,27,30). In the genesis of these cysts a causative role of mechanical ventilation is regarded as probable but not yet definitely proven.…”

Section: Discussionmentioning

confidence: 99%

CT and Chest Radiography in the Evaluation of Adult Respiratory Distress Syndrome

Tagliabue¹,

Casella²,

Zincone³

et al. 1994

Acta Radiol

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“…In a study of 88 abdominal computed tomography examinations of critically ill surgical patients for reasons such as suspected abdominal focus (74%), acute necrotizing pancreatitis (12%) or suspected delayed intra-abdominal organ lesion after trauma (14%) [17] the results of the examination resulted in a change of therapy (operation or other invasive therapeutic intervention) in 43% of the patients. Similar studies of thoracic computed tomography in critically ill patients (predominantly trauma patients) to evaluate a potential pulmonary septic focus or a cause for a deterioration in gas exchange resulted in therapeutic consequences or a change in patient management in up to 70% of patients [18,19,20]. …”

Section: Efficiency and Cost-effectivenessmentioning

confidence: 99%

Untitled

Waydhas¹

1999

Crit Care

253

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BackgroundThis review on the current literature of the intrahospital transport of critically ill patients addresses type and incidence of adverse effects, risk factors and risk assessment, and the available information on efficiency and cost-effectiveness of transferring such patients for diagnostic or therapeutic interventions within hospital. Methods and guidelines to prevent or reduce potential hazards and complications are provided.MethodsA Medline search was performed using the terms 'critical illness', 'transport of patients', 'patient transfer', 'critical care', 'monitoring' and 'intrahospital transport', and all information concerning the intrahospital transport of patients was considered.ResultsAdverse effects may occur in up to 70% of transports. They include a change in heart rate, arterial hypotension and hypertension, increased intracranial pressure, arrhythmias, cardiac arrest and a change in respiratory rate, hypocapnia and hypercapnia, and significant hypoxaemia. No transport-related deaths have been reported. In up to one-third of cases mishaps during transport were equipment related. A long-term deterioration of respiratory function was observed in 12% of cases. Patient-related risk indicators were found to be a high Therapeutic Intervention Severity Score, mechanical ventilation, ventilation with positive end-expiratory pressure and high injury severity score. Patients' age, duration of transport, destination of transport, Acute Physiology and Chronic Health Evaluation II score, personnel accompanying the patient and other factors were not found to correlate with an increased rate of complications. Transports for diagnostic procedures resulted in a change in patient management in 40-50% of cases, indicating a good risk:benefit ratio.ConclusionsTo prevent adverse effects of intrahospital transports, guidelines concerning the organization of transports, the personnel, equipment and monitoring should be followed. In particular, the presence of a critical care physician during transport, proper equipment to monitor vital functions and to treat such disturbances immediately, and close control of the patient's ventilation appear to be of major importance. It appears useful to use specifically constructed carts including standard intensive care unit ventilators in a selected group of patients. To further reduce the rate of inadvertent mishaps resulting from transports, alternative diagnostic modalities or techniques and performing surgical procedures in the intensive care unit should be considered.

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“…Pneumothoraces are frequently difficult to detect on anteroposterior radiographs taken of critically ill patients in the supine position, but they may be suspected or diagnosed by gas found in the minor fissure [36], the anterior costophrenic sulcus (the so-called deep-sulcus sign) (Fig 6), the subpulmonic space, or adjacent to the mediastinum and descending aorta [38]. Erect or decubitus films may confirm the pneumothorax, or unsuspected gas around the lung may be found on computed tomography of the chest [39]. The consequences and treatment of pneumothorax are well known and are not reviewed here.…”

Section: Mechanisms Of Injurymentioning

confidence: 99%

Pulmonary Barotrauma in the Intensive Care Unit

Powner

1988

J Intensive Care Med

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Disruption of lung parenchyma by airway gas (baro trauma) frequently occurs in the intensive care unit. Gas may move from the airspace into several abnormal loca tions as a result of dissection along anatomical fascial planes to potentially produce interstitial emphysema, subpleural cysts, pneumomediastinum, subcutaneous emphysema, pneumopericardium, pneumothorax, pneu moperitoneum, pneumoretroperitoneum, bronchopleu ral fistulas, and air-entry into blood vessels. Although usually of limited clinical consequence, this extra-alve olar air may produce clinically significant morbidity and mortality. Recognition of these potential complications of pulmonary disease and its therapy may assist the clini cian in correctly diagnosing, avoiding, and treating the manifestations of pulmonary barotrauma.

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Thoracic computed tomography in the critically ill patient

Cited by 22 publications

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CT and Chest Radiography in the Evaluation of Adult Respiratory Distress Syndrome

CT and Chest Radiography in the Evaluation of Adult Respiratory Distress Syndrome

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Pulmonary Barotrauma in the Intensive Care Unit

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