Sonographic patterns of lung consolidation in mechanically ventilated patients with and without ventilator-associated pneumonia: A prospective cohort study.

Berlet, Thomas Karl; Etter, Reto; Fehr, Tobias Martin; Berger, David; Sendi, Parham; Merz, Tobias Michael (2015). Sonographic patterns of lung consolidation in mechanically ventilated patients with and without ventilator-associated pneumonia: A prospective cohort study. Journal of critical care, 30(2), pp. 327-333. Elsevier 10.1016/j.jcrc.2014.11.021

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PURPOSE Thoracic ultrasound (TUS) has been successfully used in the diagnosis of community-acquired pneumonia. Little is known about its diagnostic potential in ventilator-associated pneumonia (VAP). The purpose of this study was to systematically describe the morphology and temporal changes of sonographic patterns in mechanically ventilated patients and to evaluate the diagnostic performance characteristics of TUS-based VAP diagnoses. MATERIALS AND METHODS Patients who were placed on invasive ventilation for reasons other than pneumonia and who were considered at risk for the development of VAP received daily TUS examinations while being closely monitored for the development of pneumonia. RESULTS Fifty-seven patients were studied. The incidence of VAP was 21.1%. Sonographic patterns of reduced or absent lung aeration were found in 64.2% of examinations. The sonographic pattern of lung consolidation with either dynamic or static air bronchograms was 100% sensitive and 60% specific for VAP in those patients who developed clinical signs and symptoms compatible with pneumonia. The pretest and posttest probabilities were 0.38 and 0.6, respectively. CONCLUSIONS Sonographic patterns of abnormal aeration are frequently observed in mechanically ventilated patients. If sonographic lung consolidation with either static or dynamic air bronchograms is absent, VAP is highly unlikely. The presence of these sonographic patterns in patients with signs and symptoms suggestive of pneumonia significantly increases the probability of VAP.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Berlet, Thomas Karl; Etter, Reto; Fehr, Tobias Martin; Berger, David; Sendi, Parham and Merz, Tobias Michael

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0883-9441

Publisher:

Elsevier

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

16 Feb 2015 11:08

Last Modified:

19 Oct 2015 11:09

Publisher DOI:

10.1016/j.jcrc.2014.11.021

PubMed ID:

25499414

Uncontrolled Keywords:

Pneumonia, ventilator-associated Technology assessment, biomedical Ultrasonography

BORIS DOI:

10.7892/boris.62818

URI:

https://boris.unibe.ch/id/eprint/62818

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