Transthoracic ultrasound in the diagnosis and follow up of ventilator-associated pneumonia

M. Metwally (Assiut, Egypt), O. Elshennawy (Assiut, Egypt), N. Ali (Assiut, Egypt), D. Ragab (Assiut, Egypt)

Source: Respiratory Failure and Mechanical Ventilation Conference 2022 - Opening session: Essentials of respiratory physiology - Assessment of respiratory muscle function - Pulmonary infections in mechanically ventilated patients - Telemonitoring of patients with chronic respiratory failure - Diagnostics and interventions - Acute respiratory failure: COVID-19 - Interstitial lung disease and pulmonary hypertension - Early rehabilitation - Acute respiratory failure: Invasive mechanical ventilation - HFNO and NIV for acute hypoxemic failure - Longterm NIV miscellaneous - Controversies in acute respiratory failure - The role of respiratory muscle dysfunction in weaning failure - Transitions in chronic NIV - New insights in weaning from invasive ventilation - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Difficult weaning from mechanical ventilation - Chronic ventilatory support in different diseases: Is one way fitting all? - Strategies to optimise early mobilisation and rehabilitation in intensive care - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Acute respiratory failure: Hypercapnic and diagnosis

Session: Acute respiratory failure: Hypercapnic and diagnosis
Session type: Oral poster discussion
Number: 99

Abstract

Introduction: Patients in the ICU on mechanical ventilation (MV) are at risk of nosocomial infection. Pneumonia is the second most common nosocomial infection in critically ill patients. Ventilator associated pneumonia (VAP) is defined as pneumonia occurring more than 48 hours after patients have been intubated and received mechanical ventilation. Diagnosis of VAP requires a high clinical suspicion combined with bedside examination, radiographic examination, microbiologic analysis of respiratory secretions, and blood test. transthoracic ultrasound is a good, non invasive method for diagnosis and following-up.

Aim of the study: to evaluate the performance of bedside transthoracic ultrasound for VAP diagnosis and follow-up.

Patients and methods: A prospective cohort study was conducted on 74 MV patients, with total number of 54 with high likelihood of vap and 20 with low likelihood of vap according to Clinical pulmonary infection score (CPIS) = 6 points. Transthoracic Ultrasound (TTUS) was performed within 24 hours of this point. Examination specifically identified the presence of the following ultrasound findings: B lines, consolidations (sub pleural or lobar), linear air bronchogram and pleural effusion. Follow up has been done once daily for one week.

Results:

Indices	B lines	Consolidation	effusion	air bronchogram	Total score
Senstivity	56%	82%	19%	19%	81.5%
Specificity	90%	80%	90%	100%	82%
PPV	94%	92%	83%	100%	92%
NPV	43%	82%	29%	31.2%	62%
Diagnostic acuracy	53.9%	81.5%	38.2%	40.9%	81.6%
Area under the curve	0.73	0.81	0.54	0.59	0.82
P value	< 0.001	< 0.001	0.23	< 0.001	< 0.001

Conclusions: we conclude that transthoracic ultrasound is an accurate method for the diagnosis of VAP.

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Citations should be made in the following way:
M. Metwally (Assiut, Egypt), O. Elshennawy (Assiut, Egypt), N. Ali (Assiut, Egypt), D. Ragab (Assiut, Egypt). Transthoracic ultrasound in the diagnosis and follow up of ventilator-associated pneumonia. Respiratory Failure and Mechanical Ventilation Conference 2022 - Opening session: Essentials of respiratory physiology - Assessment of respiratory muscle function - Pulmonary infections in mechanically ventilated patients - Telemonitoring of patients with chronic respiratory failure - Diagnostics and interventions - Acute respiratory failure: COVID-19 - Interstitial lung disease and pulmonary hypertension - Early rehabilitation - Acute respiratory failure: Invasive mechanical ventilation - HFNO and NIV for acute hypoxemic failure - Longterm NIV miscellaneous - Controversies in acute respiratory failure - The role of respiratory muscle dysfunction in weaning failure - Transitions in chronic NIV - New insights in weaning from invasive ventilation - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Difficult weaning from mechanical ventilation - Chronic ventilatory support in different diseases: Is one way fitting all? - Strategies to optimise early mobilisation and rehabilitation in intensive care - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Acute respiratory failure: Hypercapnic and diagnosis

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