Computed Tomography of the Chest in the Intensive Care Unit

Background Currently, there are limited data available describing the long-term outcomes of chest trauma survivors. Here, the authors sought to describe chest trauma survivor outcomes 6 months and 1 yr after discharge from the intensive care unit, paying special attention to pulmonary outcomes. Methods A cohort of 105 multiple trauma patients with blunt chest trauma admitted to the intensive care unit was longitudinally evaluated. After 6 months, a chest computed tomography scan, pulmonary function testing (PFT), and quality of life were collected in 55 of these patients. A subgroup of 38 patients was followed up for 1 yr. Results At least one abnormal PFT result was found in 39 patients (71%). Compared with normalized data of the age- and sex-matched population, physical function was decreased in 38 patients (70%). The 6-min walk distance was reduced for 29 patients (72%). Although pathologic images were observed on the chest computed tomography scan from 33 patients (60%), no relation was found between PFT and computed tomography. A ratio of arterial oxygen pressure to inspired oxygen fraction less than 200 at admission to the intensive care unit predicted an abnormal PFT result at 6 months. One year after discharge from the intensive care unit, paired comparisons showed a significant increase in forced vital capacity (P = 0.02) and Karnofsky Performance Status (P < 0.001). Conclusions Survivors of multiple traumas including chest trauma demonstrate a persistent decrease in the 6-min walk distance, impairment on PFT, and reduced pulmonary-specific quality of life.

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Low Muscularity as Assessed by Abdominal Computed Tomography on Intensive Care Unit Admission Is Associated With Mortality in a Critically Ill Asian Population

Journal of Parenteral and Enteral Nutrition ◽

10.1002/jpen.1666 ◽

2019 ◽

Vol 44 (3) ◽

pp. 425-433 ◽

Cited By ~ 1

Author(s):

Ching Choe Ng ◽

Zheng‐Yii Lee ◽

Wai Yee Chan ◽

Mohamad Fadhil Jamaluddin ◽

Lin Jun Tan ◽

...

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Critically Ill ◽

Asian Population ◽

Abdominal Computed Tomography

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DIAGNOSTIC VALUE OF WHOLE BODY COMPUTED TOMOGRAPHY (CT) IN PATIENTS OF A SURGICAL INTENSIVE CARE UNIT

Critical Care Medicine ◽

10.1097/00003246-198103000-00047 ◽

1981 ◽

Vol 9 (3) ◽

pp. 154

Author(s):

Margaret HEMMER ◽

Robert DONDELINGER

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Intensive Care ◽

Diagnostic Value ◽

Whole Body ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Whole Body Computed Tomography

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Diffuse Ischemia in Noncontrast Computed Tomography Predicts Outcome in Patients in Intensive Care Unit

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2010.10.005 ◽

2012 ◽

Vol 63 (2) ◽

pp. 129-134 ◽

Cited By ~ 3

Author(s):

Santanu Chakraborty ◽

Sean P. Symons ◽

Martin Chapman ◽

Richard I. Aviv ◽

Allan J. Fox

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Intensive Care ◽

Brain Death ◽

Functional Outcome ◽

Glasgow Coma Score ◽

Clinical Status ◽

Neurologic Outcome ◽

Diffuse Loss ◽

Noncontrast Computed Tomography

Purpose In the intensive care unit (ICU), prognosticating patients who are comatose or defining brain death can be challenging. Currently, the criteria for brain death are clinical supported by paraclinical tests. Noncontrast computed tomography (CT) shows diffuse loss of grey-white differentiation consistent with infarction. We hypothesize that the extent of hypodensity is predictive of poor neurologic outcome or brain death. Materials and Methods A total of 235 consecutive adult patients with cardiac arrest or with serious trauma admitted to ICU in 1 year were studied. Seventy met inclusion criteria. CT images were reviewed by multiple observers blinded to final outcome who assessed for loss of grey-white conspicuity. A modification of the validated Alberta Stroke Program Early CT Score (ASPECTS) was used to include non–middle cerebral artery territories. Primary outcome was death or functional disability at 3 months. Dichotomized CT scores were correlated with poor clinical status (Glasgow Coma Score < 5 and APACHE [Acute Physiology and Chronic Health Evaluation] score >19) and poor outcome (modified Rankin Scale >2). Results The CT score was ≤10 in 7 patients and >10 in 63 patients. The CT score value correlated with the severity of baseline clinical status on the Glasgow Coma Score ( r = 0.53, P < .01) and negatively with the APACHE-II score ( r = −0.27, P < .05). The CT score value negatively correlated with functional outcome ( r = −0.40, P < .01). All the patients with a CT score ≤10 died. The sensitivity of the CT score for functional outcome was 24%, and specificity was 100%. Agreement among observers for the CT score was good (Intraclass correlation coefficient = 0.77). Conclusion Diffuse loss of grey-white matter differentiation is subtle but specific for poor neurologic outcome, which may allow earlier prognostication of patients in whom clinical parameters are difficult to assess.

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Patient Transport and Brain Oxygen in Comatose Patients

Neurosurgery ◽

10.1227/01.neu.0000368543.59446.a4 ◽

2010 ◽

Vol 66 (5) ◽

pp. 925-932 ◽

Cited By ~ 19

Author(s):

Edward W. Swanson ◽

Justin Mascitelli ◽

Michael Stiefel ◽

Eileen MacMurtrie ◽

Joshua Levine ◽

...

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Intensive Care ◽

Lung Function ◽

Parameter Estimate ◽

Brain Hypoxia ◽

Average Decrease ◽

Brain Oxygen ◽

Before And After ◽

Head Computed Tomography

Abstract OBJECTIVE Transport of critically ill intensive care unit patients may be hazardous. We examined whether brain oxygen (brain tissue oxygen partial pressure [PbtO2]) is influenced by transport to and from a follow-up head computed tomography (transport head computed tomography [tHCT]) scan. METHODS Forty-five patients (24 men, 21 women; Glasgow Coma Scale score ≤8; mean age, 47.3 ± 19.0 years) who had a traumatic brain injury (n = 26) or subarachnoid hemorrhage (n = 19) were retrospectively identified from a prospective observational cohort of PbtO2 monitoring in a neurosurgical intensive care unit at a university-based level I trauma center. PbtO2, intracranial pressure, and cerebral perfusion pressure were monitored continuously and compared during the 3 hours before and after 100 tHCT scans. RESULTS The mean PbtO2 before and after the tHCT scans for all 100 scans was 37.9 ± 19.8 mm Hg and 33.9 ± 17.2 mm Hg, respectively (P = .0001). A decrease in PbtO2 (>5%) occurred after 54 tHCTs (54%) and in 36 patients (80%). In instances in which a decrease occurred, the average decrease in mean, minimum, and maximum PbtO2 was 23.6%, 29%, and 18.1%, respectively. This decrease was greater when PbtO2 was compromised (<25 mm Hg) before tHCT. An episode of brain hypoxia (<15 mm Hg) was identified in the 3 hours before tHCT in 9 and after tHCT in 19 instances. On average, an episode of brain hypoxia was 46.6 ± 16.0 (standard error) minutes longer after tHCT than before tHCT (P = .008). Multivariate analysis suggests that changes in lung function (PaO2/fraction of inspired oxygen [FiO2] ratio) may account for the reduced PbtO2 after tHCT (parameter estimate 0.45, 95% confidence interval: 0.024–0.871; P = .04). CONCLUSION These data suggest that transport to and from the intensive care unit may adversely affect PbtO2. This deleterious effect is greater when PbtO2 is already compromised and may be associated with lung function.

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Computed tomography as an adjunct to chest x-rays of intensive care unit patients

Critical Care Medicine ◽

10.1097/00003246-198803000-00001 ◽

1988 ◽

Vol 16 (3) ◽

pp. 211-216 ◽

Cited By ~ 11

Author(s):

RICHARD P. GOLDING ◽

PAUL KNAPE ◽

ROB J. M. STRACK van SCHIJNDEL ◽

DICK de JONG ◽

LAMBERTUS G. THUS

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Intensive Care ◽

X Rays

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Pneumocephalus and pneumorachis after blunt chest trauma without spinal fractures: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-019-2208-3 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 1

Author(s):

Etienne Allard ◽

Jean Selim ◽

Benoit Veber

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Intensive Care ◽

Case Report ◽

Blunt Trauma ◽

Subcutaneous Emphysema ◽

Spinal Canal ◽

Skull Fractures ◽

Computed Tomography Scan ◽

Tomography Scan

Abstract Background Pneumocephalus and pneumorachis, presence of air inside the skull and spinal canal, are mostly seen after neurosurgical procedures and neuraxial anesthesia. They have also been described after penetrating trauma, but never after blunt trauma without adjacent bone fractures. Case description We present the case of an 85-year-old white male patient admitted to our intensive care unit after a high velocity car accident. On site clinical evaluation showed normal consciousness with 15/15 Glasgow Coma Scale after a short initial loss of consciousness. The patient was first sent to a nearby hospital where a whole-body computed tomography scan revealed pneumocephalus and pneumorachis and an important left hemopneumothorax with pneumomediastinum with extensive subcutaneous emphysema. The state of the patient quickly worsened with hemorrhagic shock. The patient was sent to our intensive care unit; upon neurosurgical evaluation, no surgical indication was retained due to the absence of skull and spine fracture. A computed tomography scan performed on day 6 showed total regression of the pneumocephalus and pneumorachis. A follow-up computed tomography scan performed on day 30 revealed no intracranial bleeding or stroke, but a left pleural hernia between ribs 5 and 6. Due to respiratory complications, our patient could not be weaned from ventilator support for a proper neurological examination. Our patient’s state finally worsened with septic shock due to ventilator-acquired pneumonia leading to multiple organ failure and our patient died on day 37. Conclusions This is the first case report to describe pneumorachis and pneumocephalus following blunt trauma with pneumothorax, but no spinal or skull fractures. The mechanism that is probably involved here is a migration of air with subcutaneous emphysema and a pleural hernia into the spinal canal. However, in cases of pneumorachis or pneumocephalus, skull fractures need to be investigated as these require surgery and appropriate vaccination to prevent meningitis.

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