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

Introduction. Neurofibromatosis type 1 (NF1), also known as von Recklinghausen disease, is one of the most common single-gene disorders (mutation on chromosome 17q) and usually associated with cutaneous, musculoskeletal and neurological disorders in humans. NF1 is generally complicated with one or more neurobehavioral disorders or tumors located in the peripheral nervous system such as neurofibromas, peripheral nerve sheath tumor, pheochromocytoma, etc. In the available medical literature, the thoracic manifestations of NF1 have been rarely described in these patients. There are few reports about intrathoracic neurogenic tumors, kyphoscoliosis, pneumonitis and pulmonary fibrosis in patients with NF1. Case report. A 65-year-old female was admitted to the Intensive Care Unit at the Lung Clinic of Belgrade University Clinical Center of Serbia. The patient?s general condition was poor with shortness of breath and present cyanosis. At the same time, the skin changes similar to NF1 were noticed, which were additionally documented by her medical history and diagnosed as NF1. After the application of noninvasive mechanical ventilation and other emergency respiratory medicine measures, the patient soon felt better. The parenchymal changes were viewed by subsequent X-rays and CT scanning of the thorax. Conclusion. This is a case report presenting the NF1 associated with the abnormality of lung parenchyma established during diagnostic procedures at the Intensive Care Unit, Clinic of Pulmonology.

Download Full-text

Long-term Outcome in Chest Trauma

Anesthesiology ◽

10.1097/aln.0b013e31818a4009 ◽

2008 ◽

Vol 109 (5) ◽

pp. 864-871 ◽

Cited By ~ 26

Author(s):

Marc Leone ◽

Fabienne Brégeon ◽

François Antonini ◽

Kathia Chaumoître ◽

Aude Charvet ◽

...

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Intensive Care ◽

Chest Trauma ◽

Computed Tomography Scan ◽

Walk Distance ◽

Chest Computed Tomography ◽

Tomography Scan

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.

Download Full-text

Value of routine daily chest x-rays in the medica intensive care unit

Critical Care Medicine ◽

10.1097/00003246-198507000-00004 ◽

1985 ◽

Vol 13 (7) ◽

pp. 534-536 ◽

Cited By ~ 60

Author(s):

DANIEL S. STRAIN ◽

GARY T. KINASEWITZ ◽

LOWELL E. VEREEN ◽

RONALD B. GEORGE

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

X Rays

Download Full-text

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

Download Full-text

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

Download Full-text

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.

Download Full-text

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.

Download Full-text