Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia*

Bouhemad, Bélaïd; Liu, Zhi-Hai; Arbelot, Charlotte; Zhang, Mao; Ferarri, Fabio; Leguen, Morgan; Girard, Martin; Lü, Qin; Rouby, Jean‐Jacques

doi:10.1097/ccm.0b013e3181b08cdb

Cited by 305 publications

(280 citation statements)

References 41 publications

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“…An US imaging study provides useful information about lung aeration status, distinguishing between normal pattern, interstitial syndrome and consolidation. In patients with ventilator-associated pneumonia, an US study is an accurate tool for reaeration assessment showing a highly significant correlation with the CT scan [3]. In patients with ARDS, the US study adequately estimates PEEP-induced lung recruitment compared with the pressure-volume curve method [4].…”

Section: Discussionmentioning

confidence: 99%

Lung ultrasound in the reexpansion of pulmonary atelectasis

et al. 2011

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A 60-year-old man was admitted to our hospital complaining of dyspnea and productive cough that had been present for 24 h. One year prior, the patient had been diagnosed with amyotrophic lateral sclerosis. On admission, he was bedridden, had a tracheotomy, was ventilatordependent and fed by enteral nutrition by means of a gastrostomy tube.The vital signs were: blood pressure 120/80 mmHg, heart rate 110 beats/min, temperature 37°C. Percutaneous oxygen saturation was 85% on 80% ventilator-delivered oxygen. Physical examination revealed decreased breath sounds over the right lung and rales compatible with the presence of bronchial secretions over the left lung.A Chest x-ray study showed an opacification of the lower half of the right lung fields with mild homolateral mediastinal displacement suggesting pulmonary atelectasis ( Fig. 1). Electrocardiography was unremarkable. Blood gas analysis revealed hypocapnic respiratory failure. Other laboratory tests were normal except for a mild leucocytosis. The emergency physician performed a lung ultrasound (US), which confirmed the presence of a right pulmonary atelectasis appearing as an area of pulmonary parenchyma with a tissue-like pattern and abolished lung sliding in the presence of lung pulse (Fig. 2, Online Resource 1).In order to remove secretions, a bronchoscopy was performed while simultaneously checking for adequate pulmonary reexpansion with US imaging. As airway clearing progressed, the US study showed the appearance of an air bronchogram near the hilar pulmonary structures (Fig. 3, Online Resource 2), gradually advancing toward the peripheral parenchyma (Fig. 4, Online Resource 3) till pulmonary reexpansion was completed, as evidenced by the appearance of lung sliding and the disappearance of the tissue-like pattern (Fig. 5, Online Resource 4).After the procedure, the oxygen saturation was 95% on 40% ventilator-delivered oxygen. The physical examination revealed bilateral breath sounds. DiscussionPulmonary atelectasis is the loss of lung volume resulting from bronchial obstruction (obstructive atelectasis) or from parenchymal compression (nonobstructive atelectasis). Atelectasis produces a ventilation-perfusion mismatch, an intrapulmonary shunt, an increase in pulmonary vascular resistance and arterial hypoxemia. Furthermore, loss of aerated lung may increase the risk of pneumonia and ventilator-induced lung injury by overstretching of the aerated lung.US imaging study seems to be a useful tool for diagnosing and evaluating pulmonary atelectasis, and more Electronic supplementary material The online version of this article

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Section: Discussionmentioning

confidence: 99%

Lung ultrasound in the reexpansion of pulmonary atelectasis

et al. 2011

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“…A statistically significant correlation was found between this score and CT assessment of lung re-aeration following efficient antimicrobial therapy in patients with ventilatorassociated pneumonia. 22 Following PEEP administration to patients with ARDS, a significant correlation was found between alveolar recruitment measured by the PV curve method and the ultrasound re-aeration score. 4 Bedside monitoring of alveolar recruitment (or derecruitment) has entered the clinical area and should improve in the close future the ventilatory management of patients with ARDS.…”

Section: Methods Based On Transthoracic Lung Ultrasoundmentioning

confidence: 95%

“…Following any therapy aimed at improving lung aeration, each region of interest may vary between 4 conditions: normal aeration (lung sliding and horizontal A lines), moderate loss of lung aeration related to interstitial syndrome (multiple spaced vertical B lines), severe loss of lung aeration related to alveolar-interstitial syndrome (coalescent vertical B lines), and complete loss of lung aeration caused by alveolar consolidation or atelectasis. 22 By adding changes in ultrasound pattern detected in each region of interest, ultrasound scores or re-aeration have been proposed and correlated to reference methods for quantifying lung aeration changes (computed tomography, extravascular lung water, pulmonary wedge pressure, PV curves, lung lavage for alveolar proteinosis). 4,[22][23][24][25][26][27] Bedside transthoracic lung ultrasound has been demonstrated to be accurate for assessing re-aeration following fluid depletion in patients with hemodynamic pulmonary edema, PEEP-induced alveolar recruitment in ARDS, 4 lung re-aeration resulting from efficient antimicrobial therapy in patients with community-acquired 28 or ventilator-associated pneumonia, 22 and derecruitment observed at the early phase of acute lung injury 29 or during a spontaneous breathing trial.…”

Section: Methods Based On Transthoracic Lung Ultrasoundmentioning

confidence: 99%

Measurement of Alveolar Recruitment at the Bedside: The Beginning of a New Era in Respiratory Monitoring?

et al. 2013

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“…One limitation of lung US is that the measurements do not quantify physical findings. Even though an aeration score has been developed, it is not quantitative as the Hounsfield units are for CT [3]. This US aeration score has been shown to correlate with PEEP-induced recruited lung volume obtained from the pressure-volume curve [4] and with weaning failure during spontaneous breathing trial [5].…”

mentioning

confidence: 99%

Assessment of oxygenation response to prone position ventilation in ARDS by lung ultrasonography

Guérin

Gattinoni

2016

Intensive Care Med

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Acute respiratory distress syndrome (ARDS) is of major concern for the intensivist, as ARDS can only be treated in the intensive care unit (ICU). A cornerstone treatment is mechanical ventilation in order to buy time while the disease leading to ARDS can be cured. Therefore, the first aim of mechanical ventilation is to maintain a viable gas exchange. Over the years we realized that the cost of mechanical ventilation, as measured by the occurrence of ventilator-induced lung injury (VILI) [1], was too high if the target of the mechanical ventilation was normal blood gases. From there, permissive hypercapnia and oxygen saturation between 85 and 90 % were accepted to decrease the risk of VILI.To better tailor the ventilator settings, particularly to avoid potentially dangerous intratidal collapse and decollapse, increased attention was devoted to the characterization of the pathology underlying ARDS. To date, lung CT scan is the gold standard to assess the distribution of strain and from there to make inferences to minimize the occurrence of VILI. It should be mentioned, however, that no study demonstrated that patient outcome can be influenced from lung CT scan findings, essentially because no study has been done with this objective. Since ARDS lung characteristics cannot be monitored using CT imaging, methods feasible at the bedside are very attractive and lung ultrasound (US) is one of them [2]. One limitation of lung US is that the measurements do not quantify physical findings. Even though an aeration score has been developed, it is not quantitative as the Hounsfield units are for CT [3]. This US aeration score has been shown to correlate with PEEP-induced recruited lung volume obtained from the pressure-volume curve [4] and with weaning failure during spontaneous breathing trial [5]. Recently, however, it was shown that recruitment measured by CT scan (as re-inflation of previously not inflated regions) is not correlated with recruitment measured by the pressure-volume curve [6]. This last method and, by inference the US method, actually measure together both the aeration of previously non-aerated regions and a better inflation of lung regions already aerated. The regional hyperinflation, however, cannot be measured accurately either with CT (because of the mass increase of the ARDS lung) or lung US.Haddam et al.[7] performed a multicenter study in 51 ARDS patients with the aim to predict the oxygenation response to the prone position session from using lung US aeration score. The patients included suffered equally from either primary or secondary lung injury and received appropriate lung-protective mechanical ventilation. The authors found that changes in PaO 2 /F I O 2 ratio and lung aeration score did not correlate in either early or late stage of prone position regardless of the focal or nonfocal nature of ARDS. The same was true for changes in PaCO 2 . For the oxygenation to increase, and for the PaCO 2 to decrease, from increased regional lung aeration the blood should continue to flow towards those rea...

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Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia*

Abstract: Lung reaeration can be accurately estimated with bedside lung ultrasound in patients with ventilator-associated pneumonia treated by antibiotics. Lung ultrasound can also detect the failure of antibiotics to reaerate the lung.

Cited by 305 publications

References 41 publications

Lung ultrasound in the reexpansion of pulmonary atelectasis

Lung ultrasound in the reexpansion of pulmonary atelectasis

Measurement of Alveolar Recruitment at the Bedside: The Beginning of a New Era in Respiratory Monitoring?

Assessment of oxygenation response to prone position ventilation in ARDS by lung ultrasonography

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