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

Abstract

No 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.

Early surfactant replacement guided by lung ultrasound in preterm newborns with RDS: the ULTRASURF randomised controlled trial

“…Moreover, LUS seems to predict the need for surfactant administration better than FiO 2 . Also, LUS may help to identify those patients who do not require surfactant treatment and may help clinicians to identify other causes, apart from RDS, of hypoxia and non-invasive ventilation failure, so they can treat the patient accordingly [23,31,32].…”

The Role of Lung Ultrasound Monitoring in Early Detection of Ventilator-Associated Pneumonia in COVID-19 Patients: A Retrospective Observational Study

“…A LUPPIS score >7 was more accurate in VAP diagnosis compared to CPIS >6 (AUC 0.952, 84% sensitivity and 87.7% specificity vs. AUC 0.822, 44% sensitivity and 83% specificity) [ 47 ]. A similar score was also recently applied in neonates and the LUS accuracy was confirmed in this context (AUC 0.91, 94% sensitivity, and 67% specificity) [ 48 ]. Besides the diagnostic application, the changes in air bronchograms have been investigated as promising prognostic tools.…”

The association between clinical and biochemical characteristics of late-onset sepsis and bronchopulmonary dysplasia in preterm infants

“…Furthermore, the results might be hampered by residual confounding given the potential clinical differences between the two populations, although the pulmonary condition prior to the LOS was not significant different. In addition, during the study period, pulmonary ultrasound was not used as diagnostic tool to rule out a ventilator acquired pneumonia [ 32 ]. Therefore, in this study, we cannot differentiate between pulmonary deterioration due to mechanical ventilation versus a ventilation acquired pneumonia secondary to this mechanical ventilation episode.…”