Skip to main content
SpringerLink
Log in

Prevalence of pulmonary hypertension associated with severe acute respiratory distress syndrome: Predictive value of computed tomography

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To evaluate the prevalence of pulmonary hypertension associated with severe acute respiratory distress syndrome (ARDS) and to asses the value of pulmonary artery trunk diameter (PAT) to predict pulmonary hypertension.

Design

Prospective study

Setting

University teaching hospital and ARDS referral center.

Patients

103 patients with ARDS, who received both right heart catheterization and chest computed tomography.

Interventions

None.

Measurements and results

95 patients (92.2%) with ARDS had pulmonary artery hypertension, 16 of them (16.8%) mild, 72 (75.8%) moderate, and 7 (7.4%) severe, as assessed by right heart catheterization. Of the patients with moderate and severe pulmonary hypertension, 43 had a pulmonary artery trunk diameter ≥ 29 mm yielding a sensitivity of 0.54 and a specificity of 0.63. Pulmonary artery trunk diameter correlated significantly but weakly with mean pulmonary artery pressure (r = 0.34, p = 0.0004). The positive predictive value was 0.83, and the negative predictive value was 0.28. The diagnosis of pulmonary hypertension by PAT diameter measurements was incorrect in 43.7% of patients with ARDS.

Conclusions

Pulmonary artery hypertension has a high prevalence in patients with severe ARDS. Measurement of PAT diameter on admission CT scan is an unreliable tool for identification of ARDS patients with pulmonary hypertension.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Oswald-Mammosser M, Weitzenblum E, Quoix E, Moser G, Chaouat A, Charpentier C, Kessler R (1995) Prognostic factors in COPD patients receiving long-term oxygen therapy: importance of pulmonary artery pressure. Chest 107:1193–1198

    Article  PubMed  CAS  Google Scholar 

  2. Olschewski H, Simonneau G, Galiè N, Higenbottam T, Naeije R, Rubin LJ, Nikkho S, Speich R, Hoeper MM, Behr J, Winkler J, Sitbon O, Popov W, Ghofrani HA, Manes A, Kiely DG, Ewert R, Meyer A, Corris PA, Delcroix M, Gomez-Sanchez M, Siedentop H, Seeger W, the Aerosolized Iloprost Randomized Study Group (2002) Inhaled Iloprost for severe pulmonary hypertension. N Engl J Med 347:322–329

    Article  PubMed  CAS  Google Scholar 

  3. Rubin  LJ, Badesch DB, Barst RJ, Galiè N, Black CM, Keogh A, Pulido T, Frost A, Roux S, Leconte I, Landzberg M, Simonneau G, the Bosentan Randomized Trial of Endothelin Antagonist Therapy Study Group (2002) Bosentan therapy for pulmonary arterial hypertension. N Engl J Med 346:896–903

    Article  PubMed  CAS  Google Scholar 

  4. Sastry BK, Narasimhan C, Reddy NK, Raju BS (2004) Clinical efficacy of sildenafil in primary pulmonary hypertension. J Am Coll Cardiol 43:1149–1153

    Article  PubMed  CAS  Google Scholar 

  5. Berger M, Haimowitz A, Van Tosh A, Berdorff RL, Goldberg E (1985) Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasound. J Am Coll Cardiol 6:359–365

    Article  PubMed  CAS  Google Scholar 

  6. Currie PJ, Seward JB, Chan KL, Fyfe DA, Hagler DJ, Mair DD, Reeder GS, Nishimura RA, Tajik AJ (1985) Continuous wave Doppler estimation of right ventricular pressure: a simultaneous Doppler-catheterization study in 127 patients. J Am Coll Cardiol 6:750–756

    PubMed  CAS  Google Scholar 

  7. Tan RT, Kuzo R, Goodman LR, Siegel R, Haasler GB, Presberg KW (1998) Utility of CT scan evaluation for predicting pulmonary hypertension in patients with parenchymal lung disease. Chest 113:1250–1256

    Article  PubMed  CAS  Google Scholar 

  8. Krüger S, Haage P, Hoffmann R, Breuer C, Bücker A, Hanrath P, Günther RW (2001) Diagnosis of pulmonary arterial hypertension and pulmonary embolism with magnetic resonance angiography. Chest 120:1556–1561

    Article  PubMed  Google Scholar 

  9. Arcasoy SM, Christie JD, Ferrari VA, Sutton MSJ, Zisman DA, Blumenthal NP, Pochettino A, Kotloff RM (2003) Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease Am J Respir Crit Care Med 167:735–740

    Google Scholar 

  10. Zapol WM, Snider MT (1977) Pulmonary hypertension in severe acute respiratory failure. N Engl J Med 296:476–480

    PubMed  CAS  Google Scholar 

  11. Squara P, Dhainaut JFA, Artigas A, Carlet J, the European Collaborative ARDS working group (1998) Hemodynamic profile in severe ARDS: result of the European Collaborative ARDS study. Intensive Care Med 24:1018–1028

    Article  PubMed  CAS  Google Scholar 

  12. Richard C, Warszawski J, Anguel N, Deye N, Combes A, Barnoud D, Boulain T, Lefort Y, Fartoukh M, Baud F, Boyer A, Brochard L, Teboul JL, for the French Pulmonary Artery Catheter Study Group (2003) Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome. A randomized controlled trial. JAMA 290:2713–2720

    Article  PubMed  CAS  Google Scholar 

  13. The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308

    Article  PubMed  Google Scholar 

  14. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R, The American–European Consensus Conference on ARDS (1994) Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824

    PubMed  CAS  Google Scholar 

  15. Murray JF, Matthay MA, Luce JM, Flick MR (1988) An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 138:720–723

    PubMed  CAS  Google Scholar 

  16. Edwards PE, Bull RK, Coulden R (1998) CT measurement of main pulmonary artery diameter. Br J Radiol 71:1018–1020

    PubMed  CAS  Google Scholar 

  17. Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European / North American multicenter study. JAMA 270:2957–2963

    Article  PubMed  Google Scholar 

  18. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710

    Article  PubMed  CAS  Google Scholar 

  19. Rich S, Dantzker DR, Ayres S, Bergofsky EH, Brundage BH, Dentre KM (1987) Primary pulmonary hypertension: a national prospective study. Ann Intern Med 107:216–223

    PubMed  CAS  Google Scholar 

  20. Kuriyama K, Gamsu G, Stern RG, Cann CE, Herfkens RJ, Brundage BH (1984) CT-determined pulmonary artery diameters in predicting pulmonary hypertension. Invest Radiol 19:16–22

    Article  PubMed  CAS  Google Scholar 

  21. Lin LI (1989) A concordance correlation coefficient to evaluate reproducibility. Biometrics 45:255–268

    Article  PubMed  CAS  Google Scholar 

  22. Vieillard-Baron A, Schmitt JM, Augarde R, Fellahi JL, Prin S, Page B, Beauchet A, Jardin F (2001) Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: Incidence, clinical implications, and prognosis. Crit Care Med 29:1551–1555

    Article  PubMed  CAS  Google Scholar 

  23. Michard F, Wolff MA, Herman B, Wysocki M (2001) Right ventricular response to high-dose almitrine infusion in patients with severe hypoxemia related to acute respiratory distress syndrome. Crit Care Med 29:32–36

    Article  PubMed  CAS  Google Scholar 

  24. Haimovici JB, Trotman-Dickenson B, Halpern EF, Dec GW, Ginns LC, Shepard JA, McLoud TC (1997) Relationship between pulmonary artery diameter at computed tomography and pulmonary artery pressures at right-sided heart catheterization. Acad Radiol 4:327–34

    Article  PubMed  CAS  Google Scholar 

  25. Dini FL, Nuti R, Barsotti L, Baldini U, Dell'Anna R, Micheli G (2002) Doppler-derived mitral and pulmonary venous flow variables are predictors of pulmonary hypertension in dilated cardiomyopathy. Echocardiography 19:457–465

    Article  PubMed  Google Scholar 

  26. Penning S, Robinson KD, Major CA, Garite TJ (2001) A comparison of echocardiography and pulmonary artery catheterization for evaluation of pulmonary artery pressures in pregnant patients with suspected pulmonary hypertension. Am J Obstet Gynecol 184:1568–1570

    Article  PubMed  CAS  Google Scholar 

  27. Marinelli WA, Weinert CR, Gross CR, Knoedler JP, Bury CL, Kangas JR, Leatherman JW (1999) Right heart catheterization in acute lung injury. An observational study. Am J Respir Crit Care Med 160:69–76

    PubMed  CAS  Google Scholar 

  28. Hemmila MR, Rowe SA, Boules TN, Miskulin J, McGillicuddy JW, Schuerer DJ, Haft JW, Swaniker F, Arbabi S, Hirschl RB, Bartlett RH (2004) Extracorporeal life support for severe acute respiratory distress syndrome in adults. Ann Surg 240:595–607

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Martin Beiderlinden & Jürgen Peters

  2. Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum, Universität Duisburg-Essen, Essen, Germany

    Hilmar Kuehl

  3. Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum, Universität Duisburg-Essen, Essen, Germany

    Tanja Boes

Authors
  1. Martin Beiderlinden
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hilmar Kuehl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tanja Boes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jürgen Peters
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Beiderlinden.

Electronic Supplementary Material

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beiderlinden, M., Kuehl, H., Boes, T. et al. Prevalence of pulmonary hypertension associated with severe acute respiratory distress syndrome: Predictive value of computed tomography. Intensive Care Med 32, 852–857 (2006). https://doi.org/10.1007/s00134-006-0122-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-006-0122-9

Keywords

Search

Navigation