respiratory anaesthesia-icu

Lung Injury Prediction Score (LIPS)

Lung Injury Prediction Score (LIPS) identifies patients at risk for developing Acute Lung Injury (ALI) / ARDS early in the hospital course (before ALI is established). Enables early preventive strategies (lung-protective ventilation, restrictive fluid strategy, avoidance of blood products). Validated by Gajic et al. 2011 in 5,584 patients. Score above 4 = high risk (ALI development rate 18% vs 3% for low risk).

Shock (systolic BP below 90 mmHg or vasopressor use)*

Aspiration (clinical evidence of aspiration of gastric contents)*

Sepsis (infection with SIRS criteria)*

Pneumonia (new infiltrate on CXR with clinical evidence of infection)*

Fraction of inspired oxygen (FiO2) above 0.35 or oxygen above 4 L/min to maintain SpO2 above 90%*

SpO2 below 95% on any supplemental oxygen*

Obesity (BMI above 30 kg/m2)*

Diabetes mellitus*

Harmful alcohol use (above 14 units/week)*

Hypoalbuminaemia (albumin below 26 g/L)*

Score interpretation

Low ALI/ARDS Risk (LIPS at or below 4) -99–4

LIPS at or below 4 -- lower risk of developing ALI/ARDS

→ Standard care; if mechanically ventilated: use lung-protective ventilation (TV 6-8 mL/kg predicted body weight) prophylactically regardless of LIPS; conservative fluid strategy where clinically safe; avoid unnecessary blood transfusions; minimize sedation; early enteral nutrition; head of bed at 30-45 degrees; reassess daily.

High ALI/ARDS Risk (LIPS above 4) 4.1–99

LIPS above 4 -- high risk of ALI/ARDS; implement preventive strategies

→ Intensivist awareness and proactive prevention: (1) Lung-protective ventilation from the outset if intubated -- TV 6 mL/kg predicted body weight, plateau pressure below 30 cmH2O, PEEP 5-8 cmH2O; (2) Restrictive fluid strategy (target zero fluid balance or slight negative balance); (3) Minimise blood product use (threshold for RBC below 70 g/L, FFP only for active bleeding/coagulopathy); (4) Avoid gastric over-distension and aspiration risk; (5) Treat underlying cause urgently (antibiotics, source control); (6) Consider HFNC if not intubated and SpO2 borderline; monitor P/F ratio and bilateral CXR daily; if Berlin ARDS criteria met: full ARDS protocol.

Interpretation bands for the LIPS Score. Apply clinical judgement and local guidance.

References

Gajic O et al. Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study. Am J Respir Crit Care Med. 2011;183(4):462-470.
ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-2533.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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