ArticleThorax2018
Severity scoring of lung oedema on the chest radiograph is associated with clinical outcomes in ARDS.
Article in Thorax, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07536477 (High-flow Nasal Cannula Oxygen Therapy Versus Conventional Oxygen Therapy in Patients With High-altitude Pulmonary Edema), which is not on this map. Cited by 210 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
High-flow Nasal Cannula Oxygen Therapy Versus Conventional Oxygen Therapy in Patients With High-altitude Pulmonary Edema: A Prospective Randomized Controlled Study
Who cites it
210 citing papers in PubMed, 409 citations in OpenAlex.
- Treatment with Allogeneic Mesenchymal Stromal Cells for Moderate to Severe Acute Respiratory Distress Syndrome: A Double-Blind, Placebo-controlled, Multicenter Phase 2b Clinical Trial (STAT).American journal of respiratory and critical care medicine · 2026Trial
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- Post-hoc mediation analysis of two biomarkers, and survival in acute respiratory distress syndrome.Scientific reports · 2025Trial
- Longitudinal phenotypes in patients with acute respiratory distress syndrome: a multi-database study.Critical care (London, England) · 2022Trial
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- Evaluation of Adjunctive Photobiomodulation (PBMT) for COVID-19 Pneumonia via Clinical Status and Pulmonary Severity Indices in a Preliminary Trial.Journal of inflammation research · 2021Trial
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- Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy.Clinical immunology (Orlando, Fla.) · 2020Trial
- Albumin in the Management of Hepatorenal Syndrome-Acute Kidney Injury: Is There Ever Too Much?Digestive diseases and sciences · 2026Article
- Lung ultrasound aeration score in pediatric ARDS: associations with oxygenation impairment and RALE score.European journal of pediatrics · 2026Observational
- Improving inter-rater reliability in radiographic edema scoring in acute respiratory failure through structured training and expert feedback.ATS scholar · 2026Article
- Quantifying diffuse airspace disease on portable chest radiographs in acute respiratory failure using the RALE score.Intensive care medicine experimental · 2026Article
- CT-based AI system for quantitative and integrated management of acute respiratory distress syndrome in critical care.NPJ digital medicine · 2026Article
- Measuring and managing pulmonary edema in ARDS: a narrative review.Critical care (London, England) · 2026Review
- Outcome and Oxygenation Response to Airway Pressure Release Ventilation (APRV) Used as a Rescue Strategy for Severe Hypoxemic Respiratory Failure-An Observational Study.Journal of clinical medicine · 2026Article
- Fluid Balance is Associated with Differential Effects on Respiratory Failure between Critically Ill and Noncritically Ill Adults with SARS-CoV-2: a Retrospective Cohort Study.Shock (Augusta, Ga.) · 2026Article
- Use of radiograph scoring systems to assess pulmonary disease severity in patients with COVID-19 pneumonia.World journal of critical care medicine · 2026Article
- Postoperative pulmonary complications and response to recruitment maneuvers during hypoxemia in one lung ventilation.BMC anesthesiology · 2026Observational
- Redefining Acute Respiratory Distress Syndrome: A New Clinical Perspective.Tuberculosis and respiratory diseases · 2026Article
- Predictive validity of the simplified Radiographic Assessment of Lung Edema score for mortality in critically ill patients with COVID-19.Frontiers in medicine · 2026Article
150 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 3 institutions in 3 countries.
Funding
Abstract
backgroundThere is no accurate, non-invasive measurement to estimate the degree of pulmonary oedema in acute respiratory distress syndrome (ARDS). We developed the Radiographic Assessment of Lung Oedema (RALE) score to evaluate the extent and density of alveolar opacities on chest radiographs. After first comparing the RALE score to gravimetric assessment of pulmonary oedema in organ donors, we then evaluated the RALE score in patients with ARDS for its relationship to oxygenation and clinical outcomes.
methodsWe compared radiographs with excised lung weights from 72 organ donors (derivation cohort) and radiographs with clinical data from 174 patients with ARDS in the ARDSNet Fluid and Catheter Treatment Trial (validation cohort). To calculate RALE, each radiographic quadrant was scored for extent of consolidation (0-4) and density of opacification (1-3). The product of the consolidation and density scores for each of the four quadrants was summed (maximum score=48).
resultsAgreement between two independent reviewers for RALE score was excellent (intraclass correlation coefficient=0.93, 95% CI 0.91 to 0.95). In donors, pre-procurement RALE score correlated with height-adjusted total lung weight (ρ=0.59, p<0.001). In patients with ARDS, higher RALE scores were independently associated with lower PaO
conclusionsThe RALE score can be used to assess both the extent of pulmonary oedema and the severity of ARDS, by utilising information that is already obtained routinely, safely and inexpensively in every patient with ARDS. This novel non-invasive measure should be useful for assessing ARDS severity and monitoring response to therapy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.