Post-intensive care syndrome: the role of pulmonary tissue density maps in acute pulmonary injury

Aim: to determine the diagnostic role of lung tissue density maps in acute lung injury (ALI) in the assessment of Post-Intensive Care Syndrome (PICS) in patients in the intensive care unit.

Materials and Methods. 129 patients who were in inpatient and outpatient treatment with suspected risk of development and presence of acute lung injury (ALI) of primary and secondary origin were examined. The patients were observed from 2023 to 2026: they were hospitalized in the Clinical Hospital No. 1 (August 2023 – August 2024), and subsequently (September 2024 – August 2026) they were observed on an outpatient basis. All patients underwent computed tomography (CT) with additional assessment of lung tissue density maps

Study results. Based on patient follow-up data, PICS developed within 12 months in 89 (68.9%) of 129 patients. It was established that 24 (26.9%) of the 89 patients (patients with a “red pattern” based on lung tissue density maps) had PICS that developed within 12 months. Based on patients follow-up data over 24 months, signs of chronic disorders that can manifest as a consequence of critical  condition, i.e., PICS, were assessed in both the study group (n = 89) and the group of patients who did not undergo lung tissue density maps assessment (n = 57). In 21 (23.5%) cases of PICS in the main group, it occurred in isolation, while in the comparison group, the number of isolated cases was 40 (70.1%).

Conclusions.

1. Lung tissue density maps in acute lung injury have important diagnostic value in predicting and assessing PICS in ALI.
2. Patients follow-up period has shown that PICS develops within 12 months in patients with a history of ALI.
3. Diagnostic criteria of lung tissue density maps in PICS are: qualitative characteristic – “red pattern”, quantitative – more than 14%.
4. Diagnostic and prognostic role of lung tissue density map in assessing PICS (AUCROC 0.959, CI 0.914–0.986) and chest CT (AUCROC 0.793, CI 0.623–0.801) (n = 89).

1. Bitker L., Talmor D., Richard J.C. Imaging the acute respiratory distress syndrome: past, present and future. Intensive Care Med. 2022; 48 (8): 995–1008. https://doi.org/10.1007/s00134-022-06809-8

2. Hopkins R.O., Weaver L.K., Collingridge D. et al. Two-Year Cognitive, Emotional, and Quality-Of-Life Outcomes in Acute Respiratory Distress Syndrome. Am. J. Respir. Crit. Care Med. 2005; 171 (4): 340–347. https://doi.org/10.1164/rccm.200406-763OC

3. Hughes K.T., Beasley M.B. Pulmonary Manifestations of Acute Lung Injury: More Than Just Diffuse Alveolar Damage. Arch. Pathol. Lab. Med. 2017; 141 (7): 916–922. https://doi.org/10.5858/arpa.2016-0342-RA

4. Meade M.O., Herridge M.S. An evidence-based approach to acute respiratory distress syndrome. Respir. Care. 2001; 46 (12): 1368–1379. PMID: 11728297

5. Ashbaugh D.G., Bigelow D.B., Petty T.L., Levine B.E. Acute respiratory distress in adults. Lancet. 1967; 2 (7511): 319–323. https://doi.org/10.1016/s0140-6736(67)90168-7

6. Wick K.D., Ware L.B., Matthay M.A. Acute respiratory distress syndrome. Br. Med. J. 2024; 387: e076612. https://doi.org/10.1136/bmj-2023-076612

7. Blaisdell F.W., Stallone R.J. The mechanism of pulmonary damage following traumatic shock. Surg. Gynecol. Obstet. 1970; 130 (1): 15–22. PMID: 5466947

8. Kumar V. Pulmonary Innate Immune Response Determines the Outcome of Inflammation During Pneumonia and Sepsis-Associated Acute Lung Injury. Front. Immunol. 2020; 11: 1722. https://doi.org/10.3389/fimmu.2020.01722

9. McVey M.J., Steinberg B.E., Goldenberg N.M. Inflammasome activation in acute lung injury. Am. J. Physiol. Lung Cell Mol. Physiol. 2021; 320 (2): 165–178. https://doi.org/10.1152/ajplung.00303.2020

10. Ning L., Shishi Z., Bo W., Huiqing L. Targeting immunometabolism against acute lung injury. Clin. Immunol. 2023; 249: 109289. https://doi.org/10.1016/j.clim.2023.109289

11. Zilber A.P. Clinical physiology in anesthesiology and resuscitation. Moscow: Medpress-Inform, 2023: 421–426. ISBN 978-5-907632-43-1 (In Russian)

12. Ikramov A.I., Yarmuchamedova D.S., Nizamova M.M. Diagnostic imaging of acute respiratory distress syndrome of various etiologies. The Bulletin of Emergency Medicine. 2018; 11 (4): 8–12. (In Russian)

13. Intensive Care Outcomes Syndrome / Eds J.-C. Preiser, M. Heridge, E. Azoulay: translated from English by E.A. Evdokimov, A.N. Kuzovlev. Moscow: GEOTAR-Media, 2022. 584 p. ISBN 978-5-9704-6606-3 (In Russian)

14. Bormyshev A.V., Morozova T.G. Clinical and diagnostic substantiation for computed tomography of internal organs in acute lung injury in intensive care unit. Medical Alphabet. 2024; 3: 54–58. https://doi.org/10.33667/2078-5631-2024-3-54-58 (In Russian)

15. Nedomolkina I.A. Computed tomography with volumetry in the diagnosis of lung injuries and assessment of the risk of developing pulmonary complications in victims with severe combined trauma: Abstract ... diss. Cand. of Sci. (Med.). St. Petersburg, 2017. 21 p. (In Russian)

16. Speranskaya A.A. Conclusions in thoracic computed tomography. Symptom, syndrome, diagnosis. St. Petersburg: IP Makov M.Yu., 2023. 264 p. ISBN 978-5-6049248-3-9 (In Russian)

17. Kаrmаzаnovsky G.G., Zamyatina K.A., Stashkiv V.I. et al. CT diagnostics and monitoring of the course of viral pneumonia caused by the SARS-CoV-2 virus during the work of the “COVID-19 Hospital”, based on the Federal Specialized Medical Scientific Center. Medical Visualization. 2020; 24 (2): 11–36. (In Russian)

18. Parshin V.V., Berezhnaia E.E., Ketskalo M.V., Lezhnev D.A. The Computer-Tomographic Semiotics, Volume of Lung Damage and Morphological Comparisons in Patients with Severe and Extremely Severe Coronavirus Pneumonia (COVID-19). Radiology–Practice. 2021; 1 (85): 34–51. (In Russian)

19. Parshin V.V., Lezhnev D.A., Berezhnaia E.E., Mishina A.V. Computed Tomography of the Lungs as a Means of Predicting Lethal Outcome in Cancer Patients with Pneumonia Caused by the SARS-CoV-2 Virus. Radiology–Practice. 2022; (5): 39–48. https://doi.org/10.52560/2713-0118-2022-5-39-48 (In Russian)

20. Speranskaya A.A. Radiological signs of a new coronavirus infection COVID-19. Diagnostic Radiology and Radiotherapy. 2020; 11 (1): 18–25. https://doi.org/10.22328/2079-5343-2020-11-1-18-25 (In Russian)