Gajic et al reported a lung injury prediction score (LIPS) based on the LIPS of Trillo-Alvarez et al. This can help to identify a patient at increased risk for developing acute lung injury during the initial evaluation. The authors are from multiple institutions in the United States and Turkey.
Patient selection: surgical patient with at least 1 predisposing condition (shock, aspiration, sepsis, pancreatitis, pneumonia, high-risk surgery, high-risk trauma)
Exclusion: ALI on admission, hospital transfer, readmission, death in ED
Outcome: acute lung injury (ALI), adult respiratory distress syndrome (ARDS)
Parameters are based on predisposing conditions and risk modifiers.
Parameters during the initial evaluation:
(1) shock
(2) aspiration
(3) sepsis
(4) pneumonia
(5) orthopedic surgery on spine
(6) acute abdominal surgery
(7) cardiac surgery
(8) aortic vascular surgery
(9) traumatic brain injury
(10) smoke inhalation
(11) near drowning
(12) lung contusion
(13) multiple fractures
(14) alcohol abuse
(15) obesity with BMI > 30 kg per square meter
(16) hypoalbuminemia
(17) chemotherapy
(18) FIO2
(19) respiratory rate in breaths per minute
(20) oxygen saturation on pulse oximetry in percent
(21) arterial pH
(22) diabetes AND sepsis
|
Parameter |
Finding |
Points |
|
shock |
no |
0 |
|
|
yes |
2 |
|
aspiration |
no |
0 |
|
|
yes |
2 |
|
sepsis |
no |
0 |
|
|
yes |
1 |
|
pneumonia |
no |
0 |
|
|
yes |
1.5 |
|
orthopedic spinal surgery |
no |
0 |
|
|
nonemergency |
1 |
|
|
emergency |
2.5 |
|
abdominal surgery |
no |
0 |
|
|
nonemergency |
2 |
|
|
emergency |
3.5 |
|
cardiac surgery |
no |
0 |
|
|
nonemergency |
2.5 |
|
|
emergency |
4 |
|
aortic vascular surgery |
no |
0 |
|
|
nonemergency |
3.5 |
|
|
emergency |
5 |
|
traumatic brain injury |
no |
0 |
|
|
yes |
2 |
|
smoke inhalation |
no |
0 |
|
|
yes |
2 |
|
near drowning |
no |
0 |
|
|
yes |
2 |
|
lung contusion |
no |
0 |
|
|
yes |
1.5 |
|
multiple fractures |
no |
0 |
|
|
yes |
1.5 |
|
alcohol abuse |
no |
0 |
|
|
yes |
1 |
|
obesity |
no |
0 |
|
|
yes |
1 |
|
hypoalbuminemia |
no |
0 |
|
|
yes |
1 |
|
chemotherapy |
no |
0 |
|
|
yes |
1 |
|
FIO2 |
<= 0.35 (<= 4 L/min) |
0 |
|
|
> 0.35 (> 4 L/min) |
2 |
|
respiratory rate |
<= 30 breaths per minute |
0 |
|
|
> 30 breaths per minute (tachypnea) |
1.5 |
|
oxygen saturation by pulse oximetry |
>= 95% |
0 |
|
|
< 95% |
1 |
|
arterial pH |
>= 7.35 |
0 |
|
|
< 7.35 (acidosis) |
1.5 |
|
diabetes and sepsis |
no |
0 |
|
|
yes |
-1 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0 (diabetes and sepsis = (-1) + 1)
• maximum score: 41.5 (maximum in study 15.5)
• The higher the score the greater the risk for ALI/ARDS
|
Total Points |
Percent ALI/ARDS |
|
0 or 1 |
1.1% |
|
2 |
1.7% |
|
3 |
3% |
|
4 |
6% |
|
5 |
11% |
|
6 |
16% |
|
7 |
20% |
|
>= 8 |
36% |
Performance:
• The sensitivity was 0.69 and specificity 0.78.
• The area under the ROC curve is 0.80.
Specialty: Pulmonology
