Lung ultrasound: a promising tool to monitor ventilator-associated pneumonia in critically ill patients

Abstract

Ventilator-associated pneumonia (VAP) is the most frequent intensive care unit (ICU)-acquired infection that is independently associated with mortality. Accurate diagnosis and timely treatment have been shown to improve the prognosis of VAP. Chest X-ray or computed tomography imaging are used for conventional assessment of VAP, but these methods are impractical for real-time measurement in critical patients. Therefore, lung ultrasound (LUS) has been increasingly used for the assessment of VAP in the ICU. Traditionally, LUS has seemed unsuitable for the detection of lung parenchyma owing to the high acoustic impedance of air; however, the fact that the reflection and reverberation in the detection region of the ultrasound reflect the underlying pathology of lung diseases has led to the increased use of ultrasound imaging as a standard of care supported by evidence-based and expert consensus in the ICU. Considering that any type of pneumonia causes air volume changes in the lungs, accumulating evidence has shown that LUS effectively measures the presence of VAP as well as dynamic changes in VAP. This review offers evidence for ultrasound as a noninvasive, easily repeatable, and bedside means to assess VAP; in addition, it establishes a protocol for qualitative and quantitative monitoring of VAP.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1487-y) contains supplementary material, which is available to authorized users.

Diagnostic accuracy of chest ultrasound in patients with pneumonia in the intensive care unit: A single‐hospital study

“…The study concluded that broader use of lung ultrasound will allow for more timely diagnosis and implementation of appropriate therapy . A meta‐analysis of published data has also shown that LUS is a valid bedside exam to diagnose and monitor VAP, especially in the intensive care setting, and reduces patients' exposure to radiation …”

“…19 A meta-analysis of published data has also shown that LUS is a valid bedside exam to diagnose and monitor VAP, especially in the intensive care setting, and reduces patients' exposure to radiation. 20 The diagnostic sign of pneumonia on ultrasound is the presence of consolidation and interstitial syndrome, which is nonspecific. 16 Consolidation, identified in most of our cases, can also be present in obstructive atelectasis.…”

Prognostic value of lung ultrasonography after on-pump cardiac surgery

“…ассоциировалось с большим количеством В-линий, чем у пациентов без гипоксемии. Подчеркнем, что увеличение количества В-линий может указывать не только на двусторонний отек легких, характерный для острого респираторного дистресс-синдрома или сердечной недостаточности, но и на развитие очаговых изменений в легких, характерных для пневмонии и ателектазирования [25][26][27]. В частности, на развитие пневмонии или ателектазирования может указывать одностороннее или ограниченное несколькими квадрантами повышение количества В-линий [28,29].…”

“…The ROC analysis showed that increased numbers of B-lines above 10 at 6 hours after completion of the surgery was predictive of the development of X-ray abnormalities at 24 hours (AUC 0.82, р = 0.02, sensitivity 86%, specificity 76%). At 6 hours after the intervention the patients who subsequently required prolonged mechanical ventilation had increased numbers of B-lines (15 [14][15][16][17][18][19][20][21][22][23][24][25][26][27]) compared to those who could be extubated within the first 24 hours after surgery (10 [3-13], p = 0.02).…”

Lungensonografie für Anästhesie, Intensiv- und Notfallmedizin

“…[1, [11][12][13][14] Größe des Pneumothorax [1,15] Lungenödem [16][17][18][19][20][21][22][23][24] Flüssigkeitshaushalt bei Dialysepatienten [24][25][26] Pneumonie (Lungenkonsolidierung) [23,[27][28][29] Pleuraerguss und Entlastung [30][31][32][33][34][35] Pulmonalarterienembolie [2, [36][37][38] Airway Management [39][40][41] Tracheostomie [40,42] █ VIDEO Pleuralinie zustande kommen. Sie sind parallele Wiederholungslinien der Pleura in der Tiefe, die durch die nachlassende Ultraschallenergie in der Tiefe immer schwächer werden.…”