Lung Injury Prediction Score (LIPS)

LIPS Calculator

Risk Modifiers

Shock (+2)

Aspiration (+2)

Sepsis (+1)

Pneumonia (+1.5)

High-Risk Surgery

High-Risk Trauma

Alcohol abuse (+1)

Obesity BMI > 30 (+1)

Hypoalbuminemia (+1)

Diabetes (-1)

Chemotherapy (-1)

Oxygenation / Respiratory

FiO₂ > 0.35 (+2)

Respiratory rate > 30 (+1.5)

SpO₂ < 95% (+1)

Acidosis pH < 7.35 (+1.5)

LIPS: 0.0

Low Risk for ARDS

LIPS: 0.0 (<4). Low risk for developing ARDS. Continue standard monitoring.

Identifies patients at high risk for developing acute lung injury (ALI).

Why Use

Quantifies the probability that a patient will develop ALI/ARDS, allowing early, low-risk preventive interventions. Can be used to facilitate enrolment in ALI/ARDS prevention trials.

When to Use

Apply to any adult who presents with at least one classic acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) predisposing insult (e.g., sepsis, pneumonia, aspiration, major trauma) before frank lung injury is apparent. Ideally applied during the first hours of ED triage, OR/PACU hand-off, ward admission, or ICU consult.

Formula

The LIPS is calculated by the addition of the selected points: Variable Points Predisposing Conditions Shock 2 Aspiration 2 Sepsis 1 Pneumonia 1.5 High-Risk Surgery Orthopedic spine 1 Acute abdomen 2 Cardiac 2.5 Aortic vascular 3.5 If emergency surgery 1.5 High-Risk Trauma Traumatic brain injury 2 Smoke inhalation 2 Near drowning 2 Lung contusion 1.5 Multiple fractures 1.5 Risk Modifiers Alcohol abuse 1 Obesity (BMI >30) 1 Hypoalbuminemia 1 Chemotherapy 1 FiO₂ >0.35 (>4 L/min) 2 Tachypnea (respiratory rate >30) 1.5 SpO₂ <95% 1 Acidosis (pH <7.35) 1.5 Diabetes mellitus (only if sepsis) -1

Pearls / Pitfalls

At initial hospital contact, derivation and multiple validation studies demonstrated good discrimination for subsequent ALI/ARDS (AUC 0.8–0.84). Original cohorts excluded patients <18 years and pregnant patients.

Management

Score ≤4: Continue standard management and routine monitoring. Score >4: Implement an ARDS-prevention bundle. Perform close SpO₂ and work of breathing checks. Employ lung-protective ventilation (≤6 mL/kg PBW, Pplat <30 cm H₂O). Avoid high FiO₂ and high driving pressures. Use a conservative IV fluid strategy and initiate early diuresis once shock resolves. Minimise transfusions and use restrictive thresholds. Treat underlying sepsis/pneumonia with appropriate antibiotic therapy.

Advice

Always interpret the score within clinical context and expertise.

More Information

Interpretation: LIPS Risk of Acute Lung Injury ≤4 Low >4* High *At a cutoff of 4, positive and negative likelihood ratios (95% CI) for development of ALI were 3.1 and 0.4, respectively, with a sensitivity of 69% and specificity of 78% ( Gajic 2011 ).