scholarly journals Lung Ultrasound In Ventilator Associated Pneumonia: Light Or More Shadow At Diagnosis

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Abdo-Cuza A ◽  
Diaz-Aguila H ◽  
Valdes-Suarez O ◽  
Castellanos-Gutierrez R ◽  
Suarez-Lopez J ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Ventilator Associated Pneumonia

scholarly journals Ventilator-associated pneumonia in neonates: the role of point of care lung ultrasound

2020 ◽  
Vol 180 (1) ◽  
pp. 137-146
Author(s):  
Nora Tusor ◽  
Angela De Cunto ◽  
Yousef Basma ◽  
John L. Klein ◽  
Virginie Meau-Petit
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Lung Ultrasound ◽  
Clinical Laboratory ◽  
Control Group ◽  
Ventilator Associated Pneumonia ◽  
Lung Pathology ◽  
Rater Agreement ◽  
X Ray ◽  
Chest X Ray

AbstractNo consensus exists regarding the definition of ventilator-associated pneumonia (VAP) in neonates and reliability of chest X-ray (CXR) is low. Lung ultrasound (LU) is a potential alternative diagnostic tool. The aim was to define characteristics of VAP in our patient population and propose a multiparameter score, incorporating LU, for VAP diagnosis. Between March 25, 2018, and May 25, 2019, infants with VAP were identified. Clinical, laboratory and microbiology data were collected. CXRs and LU scans were reviewed. A multiparameter VAP score, including LU, was calculated on Day 1 and Day 3 for infants with VAP and for a control group and compared with CXR. VAP incidence was 10.47 episodes/1000 ventilator days. LU and CXR were available for 31 episodes in 21 infants with VAP, and for six episodes in five patients without VAP. On Day 1, a VAP score of > 4, and on Day 3 a score of > 5 showed sensitivity of 0.94, and area under the curve of 0.91 and 0.97, respectively. AUC for clinical information only was 0.88 and for clinical and CXR 0.85.Conclusion: The multiparameter VAP score including LU could be useful in diagnosing VAP in neonates with underlying lung pathology. What is Known:• Ventilator associated pneumonia (VAP) is common in infants on the neonatal unit and is associated with increased use of antibiotics, prolonged ventilation and higher incidence of chronic lung disease.• Commonly used definitions of VAP are difficult to apply in neonates and interpretation of chest X-ray is challenging with poor inter-rater agreement in patients with underlying chronic lung disease. What is New:• The multiparameter VAP score combining clinical, microbiology and lung ultrasound (LU) data is predictive for VAP diagnosis in preterm infants with chronic lung disease.• LU findings of VAP in neonates showed high inter-rater agreement and included consolidated lung areas, dynamic bronchograms and pleural effusion.

Lung Ultrasound for Early Diagnosis of Ventilator-Associated Pneumonia

CHEST Journal ◽  
2016 ◽  
Vol 149 (4) ◽  
pp. 969-980 ◽  
Author(s):  
Silvia Mongodi ◽  
Gabriele Via ◽  
Martin Girard ◽  
Isabelle Rouquette ◽  
Benoit Misset ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Lung Ultrasound ◽  
Ventilator Associated Pneumonia

scholarly journals Lung Ultrasound in Early Diagnosis of Neonatal Ventilator Associated Pneumonia before Any Radiographic or Laboratory Changes

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Mohammed Ibrahim ◽  
Ahmed Omran ◽  
Mostafa Ibrahim ◽  
Nouran Bioumy ◽  
Sonya El-Sharkawy
Keyword(s):  
Early Diagnosis ◽  
Lung Ultrasound ◽  
Ventilator Associated Pneumonia ◽  
Laboratory Findings ◽  
X Ray ◽  
Common Causes ◽  
Chest X Ray ◽  
The Common ◽  
Laboratory Changes ◽  
Radiographic Changes

Neonatal pneumonia is reported to be the primary cause of neonatal respiratory failure and one of the common causes of neonatal hospitalization and death in developing countries. Chest X-ray was considered the gold standard for diagnosis of neonatal pneumonia. Lung ultrasonography has been described as a valuable noninvasive tool for the diagnosis of many neonatal pulmonary diseases. We report a case of ventilation associated neonatal pneumonia with very early diagnosis using lung ultrasound before any significant radiographic changes in chest X-ray or laboratory findings suggestive of infection.

Emergence of Alveolar Consolidations in Serial Lung Ultrasound and Diagnosis of Ventilator-Associated Pneumonia

2019 ◽  
pp. 088506661989427 ◽  
Author(s):  
Leonardo Jönck Staub ◽  
Roberta Rodolfo Mazzali Biscaro ◽  
Rosemeri Maurici
Keyword(s):  
Mechanical Ventilation ◽  
Confidence Interval ◽  
Diagnostic Tool ◽  
Lung Ultrasound ◽  
Lung Parenchyma ◽  
Diagnostic Value ◽  
Clinical Suspicion ◽  
Ventilator Associated Pneumonia ◽  
Endotracheal Aspirate

Background: Lung ultrasound (LUS) has been reported as a promising diagnostic tool for ventilator-associated pneumonia (VAP), but patients with previous lung parenchyma commitment have been not studied. Purpose: To evaluate whether the emergence of sonographic consolidations, rather than their presence, can improve the VAP diagnosis in a sample including patients with previous lung parenchyma diseases. Methods: Patients who completed 48 hours of mechanical ventilation were prospectively studied with daily LUS examinations. We checked the emergence of different consolidation types on the eve and on the day of a clinical suspicion of VAP. We elaborated an algorithm considering, sequentially, the emergence of (1) subpleural consolidations in anterior lung regions on the eve of suspicion; (2) lobar/sublobar consolidation in anterior lung regions on the day of suspicion; (3) lobar/sublobar consolidation with dynamic air bronchograms on the day of suspicion; and (4) any other lobar/sublobar consolidation on the day of suspicion in association with a positive Gram smear of endotracheal aspirate. Results: Of the 188 included patients, 60 were suspected and 33 confirmed VAP. The presence of sonographic consolidations at the clinical suspicion had no diagnostic value for VAP. The emergence of subpleural consolidations in anterior lung regions on the eve of suspicion had specificity of 95% (95% confidence interval [CI], 79%-99%). The emergence of lobar/sublobar consolidations in anterior lung regions on the day of suspicion had specificity of 100% (95% CI, 87%-100%). The emergence of lobar/sublobar consolidations with dynamic air bronchograms on the day of suspicion had specificity of 96% (95% CI, 81%-99%). Finally, the proposed algorithm had sensitivity of 63% (95% CI, 46%-77%) and specificity of 85% (95% CI, 67%-94%) for VAP. Conclusions: The presence of sonographic consolidations was not accurate for VAP when patients with previous lung parenchyma commitment were included. However, serial LUS examinations detected the emergence of specific signs of VAP.

Accuracy and Applications of Lung Ultrasound to Diagnose Ventilator-Associated Pneumonia: A Systematic Review

2017 ◽  
Vol 33 (8) ◽  
pp. 447-455 ◽  
Author(s):  
Leonardo Jönck Staub ◽  
Roberta Rodolfo Mazzali Biscaro ◽  
Rosemeri Maurici
Keyword(s):  
Systematic Review ◽  
Lung Ultrasound ◽  
Clinical Score ◽  
Community Acquired Pneumonia ◽  
Ventilator Associated Pneumonia ◽  
Qualitative Synthesis ◽  
Diagnosis Accuracy ◽  
Ultrasound Score

Background: Lung ultrasound (LUS) is an accurate tool to diagnose community-acquired pneumonia. However, it is not yet an established tool to diagnose ventilator-associated pneumonia (VAP). Purpose: To assess the evidence about LUS in the diagnosis of VAP, we conducted a systematic review of the literature. Methods: We searched PubMed, Embase, Scopus, Web of Science, and LILACS. Two researchers independently selected the studies that met the inclusion criteria. Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the quality of the studies. In a qualitative synthesis, 3 questions guided the review: Q1. What are the sonographic signs of VAP? Q2. How can LUS be combined with others tests or signs of VAP? Q3. What is the role of LUS in VAP screening? Main Results: Three studies (n = 377 patients) with different designs were included. In terms of Q1, the 3 studies assessed the accuracy of sonographic consolidations. In patients suspected for VAP, lobar or hemilobar consolidation alone was not sufficient to diagnose VAP but seems useful to exclude it. The most useful signs were small subpleural consolidations (sensitivity: 81%; specificity: 41%) and dynamic air bronchograms (sensitivity: 44%; specificity: 81%). Two studies were assessed for Q2, when the 2 signs above were included in a clinical score (Ventilator-associated Pneumonia Lung Ultrasound Score associated with quantitative culture of endotracheal aspirate—VPLUS-EAquant), the accuracy was amplified (sensitivity: 48% and specificity: 97% for score ≥4; sensitivity: 78% and specificity: 77% for score ≥3 points). Finally, regarding Q3, no studies have assessed the use of LUS in screening of VAP. Conclusion: Small subpleural consolidations and dynamic air bronchograms were the most useful sonographic signs to diagnose VAP in suspected patients. Clinical scores including LUS had better diagnosis accuracy than LUS alone. There are no data on LUS for VAP screening.

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