Lung Ultrasound for Early Diagnosis of Ventilator-Associated Pneumonia

Background

Lung ultrasound (LUS) has been successfully applied for monitoring aeration in ventilator-associated pneumonia (VAP) and to diagnose and monitor community-acquired pneumonia. However, there is as yet no scientific evidence about whether LUS reliably improves VAP diagnosis.

Methods

In a multicenter prospective study of 99 patients with suspected VAP, we investigated the diagnostic performance of LUS findings of infection, subpleural consolidation, lobar consolidation, dynamic arborescent/linear air-bronchogram. We also evaluated the combination of LUS with direct microbiological examination of endotracheal aspirations (EA). Scores for LUS findings and EA were analyzed:-Clinical-LUS score (VPLUS Ventilator-associated Pneumonia Lung Ultrasound Score): ≥2 areas with subpleural consolidations 1 point; ≥1 area with dynamic arborescent/linear air-bronchogram 2 points; purulent EA 1 point.- VPLUS-EAgram: ≥2 areas with subpleural consolidations 1 points; ≥1 area with dynamic arborescent/linear air-bronchogram 2 points; purulent EA 1 point; positive direct gram stain EA examination 2 points.

Results

For the diagnosis of VAP, subpleural consolidation and dynamic arborescent/linear air-bronchogram had a positive predictive value of 86% with a positive likelihood ratio of 2.8. Two dynamic linear/arborescent air-bronchograms gave a positive predictive value of 94% with a positive likelihood ratio of 7.1. The area under the curve for VPLUS-EAgram and VPLUS were respectively 0.832 and 0.743. The VPLUS-EAgram ≥3 had of 77% (58-90) specificity and 78 (65-88) sensitivity; VPLUS ≥2 had 69% (50-84) specificity and 71% (58-81) sensitivity.

Conclusions

By detecting ultrasound features of infection, LUS is a reliable tool for early VAP diagnosis at the bedside.

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