PT - JOURNAL ARTICLE AU - Maurizio Cereda AU - Yi Xin AU - Hooman Hamedani AU - Giacomo Bellani AU - Stephen Kadlecek AU - Justin Clapp AU - Luca Guerra AU - Natalie Meeder AU - Jennia Rajaei AU - Nicholas J Tustison AU - James C Gee AU - Brian P Kavanagh AU - Rahim R Rizi TI - Tidal changes on CT and progression of ARDS AID - 10.1136/thoraxjnl-2016-209833 DP - 2017 Jun 20 TA - Thorax PG - thoraxjnl-2016-209833 4099 - http://thorax.bmj.com/content/early/2017/06/19/thoraxjnl-2016-209833.short 4100 - http://thorax.bmj.com/content/early/2017/06/19/thoraxjnl-2016-209833.full AB - Background Uncertain prediction of outcome in acute respiratory distress syndrome (ARDS) impedes individual patient management and clinical trial design.Objectives To develop a radiological metric of injurious inflation derived from matched inspiratory and expiratory CT scans, calibrate it in a model of experimental lung injury, and test it in patients with ARDS.Methods 73 anaesthetised rats (acid aspiration model) were ventilated (protective or non-protective) for up to 4 hours to generate a spectrum of lung injury. CT was performed (inspiratory and expiratory) at baseline each hour, paired inspiratory and expiratory images were superimposed and voxels tracked in sequential scans. In nine patients with ARDS, paired inspiratory and expiratory CT scans from the first intensive care unit week were analysed.Results In experimental studies, regions of lung with unstable inflation (ie, partial or reversible airspace filling reflecting local strain) were the areas in which subsequent progression of injury was greatest in terms of progressive infiltrates (R=0.77) and impaired compliance (R=0.67, p<0.01). In patients with ARDS, a threshold fraction of tissue with unstable inflation was apparent: >28% in all patients who died and ≤28% in all who survived, whereas segregation of survivors versus non-survivors was not possible based on oxygenation or lung mechanics.Conclusions A single set of superimposed inspiratory–expiratory CT scans may predict progression of lung injury and outcome in ARDS; if these preliminary results are validated, this could facilitate clinical trial recruitment and individualised care.