Thoracic ultrasound alone or in combination with tracheal amylase as a tool predictor of ventilator-associated pneumonia in neurocritical patients

Abstract

In this study, we aim to evaluate whether thoracic ultrasound (TUS) and tracheal amylase (TA) alone or in combination can predict the development of ventilator-associated pneumonia (VAP) in neurocritical patients. Consecutive adult patients with neurocritical disease with normal chest radiographs who required intensive care unit admission and mechanical ventilation between March 2015 and July 2018 were included. TUS and Amylase levels were measured during the first 24 hours and repeated 48 hours after orotracheal intubation. Forty-three patients with a median age of 34 years (17–82) were included. TUS had a sensitivity of 100% and specificity of 96.3% as a predictor of VAP within the first 48 hours when nonpattern A was observed. TA levels > 200 UI/L in the first 48 hours had a sensitivity of 87.5%, and specificity of 63% as a predictor of VAP. Moreover, no benefit of TUS plus TA compared to TUS alone as a predictor of VAP was found. The identification of abnormal TUS patterns in the first 48 hours of orotracheal intubation is a significant predictor of VAP in neurocritical patients.

Value of bronchial amylase level for predicting ventilator associated pneumonia in intubated adults: a systematic review and meta-analysis

“…After deduplication and precluding irrelevant records, we carefully reviewed the full text of 11 candidate studies. Finally, six studies [10,[19][20][21][22][23] met the eligibility criteria and were included in the quantitative analysis. Figure 1 shows the study selection process.…”

“…Unfortunately, no further clinical studies have been conducted to con rm above ndings until Weiss et al [10] revealed the signi cance of bronchoalveolar lavage amylase in diagnosing and differentiating VAP with high sensitivity and negative predictive value. After that, the bronchial amylase as a maker for predicting or diagnosing VAP has been extensively studied [19][20][21][22][23]39], but the results are con icting. In the present systematic review and meta-analysis, we showed that bronchial amylase can be useful as a potential marker for early detection of VAP in clinically.…”