PURPOSE: To document abnormalities at computed tomography (CT) in adult survivors of acute respiratory distress syndrome (ARDS), to determine the relationships between CT patterns during the acute phase and at follow-up, and to assess the effects of mechanical ventilation on the development of CT abnormalities.

MATERIALS AND METHODS: Thin-section CT scans were obtained during the acute illness and at follow-up in 27 patients with ARDS. The extent and distribution of individual CT patterns were independently analyzed.

RESULTS: At follow-up CT, a reticular pattern was the most prevalent (23 patients [85%]) and extensive CT abnormality, with a striking anterior distribution (more anterior distribution than posterior distribution, P < .001). A reticular pattern at follow-up was inversely correlated with the extent of intense parenchymal opacification on scans obtained during the acute illness (Spearman r = -0.26; P < .001). The extent of a reticular pattern at follow-up CT was independently related to the total duration of mechanical ventilation (P = .02) but was most strongly related to the duration of pressure-controlled inverse-ratio ventilation (P < .001).

CONCLUSION: A reticular pattern, with a striking anterior distribution, is a frequent finding of follow-up CT in ARDS survivors and is most strongly related to the duration of pressure-controlled inverse-ratio ventilation.


  • 1 Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet 1967; 2: 319-323. MedlineGoogle Scholar
  • 2 Mirvis SE, Tobin KD, Kostrubiak I, Belzberg H. Thoracic CT in detecting occult disease in critically ill patients. AJR 1987; 148: 685-689. Crossref, MedlineGoogle Scholar
  • 3 Snow N, Bergin KT, Horrigan TP. Thoracic CT scanning in critically ill patients: information obtained frequently alters management. Chest 1990; 97: 1467-1470. Crossref, MedlineGoogle Scholar
  • 4 Gattinoni L, Mascheroni D, Torresin A, et al. Morphological response to positive end expiratory pressure in acute respiratory failure: computerized tomography study. Intensive Care Med 1986; 12: 137-142. Crossref, MedlineGoogle Scholar
  • 5 Gattinoni L, Pelosi P, Vitale G, Pesenti A, D'Andrea L, Mascheroni D. Body position changes redistribute lung computed-tomographic density in patients with acute respiratory failure. Anesthesiology 1991; 74: 15-23. Crossref, MedlineGoogle Scholar
  • 6 Gattinoni L, Bombino M, Pelosi P, et al. Lung structure and function in different stages of severe adult respiratory distress syndrome. JAMA 1994; 271: 1772-1779. Crossref, MedlineGoogle Scholar
  • 7 Owens CM, Evans TW, Keogh BF, Hansell DM. Computed tomography in established adult respiratory distress syndrome: correlation with lung injury score. Chest 1994; 106: 1815-1821. Crossref, MedlineGoogle Scholar
  • 8 Bernard GR, Artigas A, Brigham KL, et al. The American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994; 149: 818-824. Crossref, MedlineGoogle Scholar
  • 9 Austin JHM, Müller NL, Friedman PJ, et al. Glossary of terms for computed tomography of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. Radiology 1996; 200: 327-331. LinkGoogle Scholar
  • 10 Rémy-Jardin M, Rémy J, Giraud F, Wattinne L, Gosselin B. Computed tomography assessment of ground-glass opacity: semiology and significance. J Thorac Imaging 1993; 8: 249-264. Crossref, MedlineGoogle Scholar
  • 11 Stern EJ, Swensen SJ, Hartman TE, Frank MS. CT mosaic pattern of lung attenuation: distinguishing different causes. AJR 1995; 165: 813-816. Crossref, MedlineGoogle Scholar
  • 12 Quanjer PH. Standardized lung function testing. Eur Respir J 1993; 6(suppl): 1-100. Google Scholar
  • 13 Wright JL. Adult respiratory distress syndrome. In: Thurlbeck WM, Churg AM, eds. Pathology of the lung. 2nd ed. New York, NY: Thieme Medical, 1995; 385-399. Google Scholar
  • 14 Pratt PC, Vollmer RT, Shelburne JD, Crapo JD. Pulmonary morphology in a multihospital collaborative extracorporeal membrane oxygenation project. I. Light microscopy. Am J Pathol 1979; 95: 191-214. Google Scholar
  • 15 Zapol WM, Trelstad RL, Coffey JW, Tsai I, Salvador RA. Pulmonary fibrosis in severe acute respiratory failure. Am Rev Respir Dis 1979; 119: 547-554. MedlineGoogle Scholar
  • 16 Howling SJ, Evans TW, Hansell DM. The significance of bronchial dilatation on CT in patients with adult respiratory distress syndrome. Clin Radiol 1998; 53: 105-109. Crossref, MedlineGoogle Scholar
  • 17 Finfer S, Rocker G. Alveolar overdistension is an important mechanism of persistent lung damage following severe protracted ARDS. Anaesth Intensive Care 1996; 24: 569-573. Crossref, MedlineGoogle Scholar
  • 18 Gattinoni L, Pelosi P, Pesenti A, et al. CT scan in ARDS: clinical and physiopathological insights. Acta Anaesthesiol Scand 1991; 35: 87-96. CrossrefGoogle Scholar
  • 19 Collins JF, Smith JD, Coalson JJ, Johanson WG, Jr. Variability in lung collagen amounts after prolonged support of acute respiratory failure. Chest 1984; 85: 641-646. Crossref, MedlineGoogle Scholar
  • 20 Webb HH, Tierney DF. Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures: protection by positive end-expiratory pressure. Am Rev Respir Dis 1974; 110: 556-565. MedlineGoogle Scholar
  • 21 Dreyfuss D, Soler P, Basset G, Saumon G. High inflation pressure pulmonary edema: respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis 1988; 137: 1159-1164. Crossref, MedlineGoogle Scholar
  • 22 Deneke SM, Fanburg BL. Normobaric oxygen toxicity of the lung. N Engl J Med 1980; 303: 76-86. Crossref, MedlineGoogle Scholar
  • 23 Last JA, Siefkin AD, Reiser KM. Type I collagen content is increased in lungs of patients with adult respiratory distress syndrome. Thorax 1983; 38: 364-368. Crossref, MedlineGoogle Scholar
  • 24 Suchyta MR, Elliott CG, Colby T, Rasmusson BY, Morris AH, Jensen RL. Open lung biopsy does not correlate with pulmonary function after the adult respiratory distress syndrome. Chest 1991; 99: 1232-1237. Crossref, MedlineGoogle Scholar
  • 25 Zwillich CW, Pierson DJ, Creagh CE, Sutton FD, Schatz E, Petty TL. Complications of assisted ventilation: a prospective study of 354 consecutive episodes. Am J Med 1974; 57: 161-170. Crossref, MedlineGoogle Scholar
  • 26 Albelda SM, Gefter WB, Kelley MA, Epstein DM, Miller WT. Ventilator-induced subpleural air cysts: clinical, radiographic, and pathologic significance. Am Rev Respir Dis 1983; 127: 360-365. MedlineGoogle Scholar
  • 27 Parker JC, Hernandez LA, Peevy KJ. Mechanisms of ventilator-induced lung injury. Crit Care Med 1993; 21: 131-143. Crossref, MedlineGoogle Scholar
  • 28 Churg A, Golden J, Fligiel S, Hogg JC. Bronchopulmonary dysplasia in the adult. Am Rev Respir Dis 1983; 127: 117-120. Crossref, MedlineGoogle Scholar
  • 29 Rotman HH, Lavelle TF, Jr, Dimcheff DG, VandenBelt RJ, Weg JG. Long-term physiologic consequences of the adult respiratory distress syndrome. Chest 1977; 72: 190-192. Crossref, MedlineGoogle Scholar
  • 30 Douglas MME, Downs JB. Pulmonary function following severe acute respiratory failure and high levels of positive end-expiratory pressure. Chest 1977; 71: 18-23. Crossref, MedlineGoogle Scholar
  • 31 Lakshminarayan S, Stanford RE, Petty TL. Prognosis after recovery from adult respiratory distress syndrome. Am Rev Respir Dis 1976; 13: 7-16. Google Scholar
  • 32 Peters JI, Bell RC, Prihoda TJ, Harris G, Andrews C, Johanson WG, Jr. Clinical determinants of abnormalities in pulmonary functions in survivors of the adult respiratory distress syndrome. Am Rev Respir Dis 1989; 139: 1163-1168. Crossref, MedlineGoogle Scholar
  • 33 Ghio AJ, Elliott CG, Crapo RO, Berlin SL, Jensen RL. Impairment after adult respiratory distress syndrome: an evaluation based on American Thoracic Society recommendations. Am Rev Respir Dis 1989; 139: 1158-1162. Crossref, MedlineGoogle Scholar
  • 34 Elliott CG, Morris AH, Cengiz M. Pulmonary function and exercise gas exchange in survivors of adult respiratory distress syndrome. Am Rev Respir Dis 1981; 123: 492-495. MedlineGoogle Scholar
  • 35 Ostrow D, Cherniack RM. Resistance to airflow in patients with diffuse interstitial lung disease. Am Rev Respir Dis 1973; 108: 205-209. MedlineGoogle Scholar
  • 36 Fulmer JD, Roberts WC, von Gal ER, Crystal RG. Small airways in idiopathic pulmonary fibrosis: comparison of morphologic and physiologic observations. J Clin Invest 1977; 60: 595-610. Crossref, MedlineGoogle Scholar

Article History

Accepted: July 20 1998
Received: Feb 04 1998
Revision received: Apr 15 1998
Revision received: May 26 1998
Published in print: Jan 1999