Early Detection of Ventilator-Associated Pneumonia: Bedside Tools
Abstract Introduction In addition to the presence of consolidation in the chest radiography (CXR) or computerized tomography (CT) scan; a group of clinical symptoms and signs are needed for the diagnosis of ventilator-associated pneumonia (VAP). Some limitations for the use of CXR and CT in intensiv...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Springer
2021-01-01
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| Series: | Egyptian Journal of Critical Care Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1097/EJ9.0000000000000015 |
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| Summary: | Abstract Introduction In addition to the presence of consolidation in the chest radiography (CXR) or computerized tomography (CT) scan; a group of clinical symptoms and signs are needed for the diagnosis of ventilator-associated pneumonia (VAP). Some limitations for the use of CXR and CT in intensive care unit (ICU) exist. The use of ultrasound imaging in ICU as a part of patient assessment is attaining more interest. Aim of the work To assess the value of lung ultrasound in comparison to chest X-ray and clinical pulmonary infection score (CPIS) as bedside tools in the diagnosis of VAP in critically ill patients while taking the CT scan as a reference. Methods Our study included 80 mechanically ventilated patients in ICU. Bedside lung ultrasound, CPIS, chest X-ray, and CT scan of chest were done for all patients on mechanical ventilator 48 hours after intubation and initiation of mechanical ventilation. The patients with documented pneumonia prior to ventilation were excluded. All data were then collected and statistically analyzed. Results By using CT chest as a golden method for diagnosis of pneumonia, 24 cases were found positive for VAP. By lung ultrasound (LUS) on day 2, 22 cases were found positive for VAP with a percentage of 91.67%. By CXR only, 18 cases were found positive for VAP with a percentage of 75.83%. By CPIS score, 22 cases were found positive for VAP with a percentage of 91.67%, but there were 28 cases suggested as VAP by the score who were false positive, whereas they were negative by CT chest. LUS has a high sensitivity of 91.67% and specificity of 100%, PPV of 100%, and NPV of 96%, which is significant versus CXR (P = .001) and significant versus CPIS > 6 (P = .001). CXR showed sensitivity of 75% and specificity of 71% with PPV of 52% and NPV of 87% whereas CPIS showed sensitivity of 91.67% and specificity of 50% with positive predictive value of 44% and negative predictive value of 93.3%, and this made P value of CXR to CPIS > 6 equal to .7, which is not significant. Conclusion LUS was suggested to be superior to the bedside chest X-ray and nearly equal to chest CT in the diagnosis of VAP. Despite being preferred in the critical care settings in ICU, the final diagnosis should be given after integration of the judgments of both lungs, taking history and the clinical examination, and it is not expected to jump to the conclusion using LUS images only. |
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| ISSN: | 2090-7303 2090-9209 |