Clinical impact of lung ultrasound monitoring for diagnosis of ventilator associated pneumonia: A diagnostic randomized controlled trial

Pradhan, Saurabh; Shrestha, Pramesh Sunder; Shrestha, Gentle Sunder; Marhatta, Moda Nath

doi:10.1016/j.jcrc.2020.03.012

Cited by 19 publications

(17 citation statements)

References 34 publications

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“…This confirms the capacity of LUS to support diagnosis and monitoring of VAP during COVID-19 ARDS, as it was described previously in other settings 25 . The clinical benefit of LUS was suggested by a recent randomized controlled trial in which ventilator-free days were increased in patients managed with LUS monitoring 26 . As an alternative to other imaging techniques such as X-rays or CT scans, LUS monitoring could also reduce their use as it was suggested by a recent study 27 .…”

Section: Discussionmentioning

confidence: 99%

Lung ultrasound score as a tool to monitor disease progression and detect ventilator-associated pneumonia during COVID-19-associated ARDS

et al. 2021

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Background Lung ultrasound can accurately detect pandemic coronavirus disease (COVID-19) pulmonary lesions. A lung ultrasound score (LUS) was developed to improve reproducibility of the technique. Objectives To evaluate the clinical value of LUS monitoring to guide COVID-19-associated acute respiratory distress syndrome (ARDS) management. Methods We conducted a single center, prospective observational study, including all patients admitted with COVID-19-associated ARDS between March and April 2020. A systematic daily LUS evaluation was performed. Results Thirty-three consecutive patients were included. LUS was significantly and negatively correlated to P aO2 /F IO2 . LUS increased significantly over time in non-survivors compared to survivors. LUS increased in 83% of ventilatory associated pneumonia (VAP) episodes, when compared to the previous LUS evaluation. LUS was not significantly higher in patients presenting post-extubation respiratory failure. Conclusions In conclusion, our study demonstrates that LUS variations are correlated to disease severity and progression, and LUS monitoring could contribute to the early diagnosis of VAPs.

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Section: Discussionmentioning

confidence: 99%

Lung ultrasound score as a tool to monitor disease progression and detect ventilator-associated pneumonia during COVID-19-associated ARDS

et al. 2021

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“…In addition, it can also be used for sequential monitoring to detect the emergence of lesions [64] or to semi-quantify lung aeration [65]. Several studies have demonstrated the utility of LUS, based on the finding of sonographic consolidation, in the assessment of VAP in the ICU setting [63][64][65][66][67][68][69]. Some of the studies distinguished small subpleural consolidation (> 0.5 cm) and lobar/hemilobar consolidation with dynamic air bronchogram [63,64,68,69].…”

Section: Clinical Studies For the Assessment Of Ventilator-associated Pneumoniamentioning

confidence: 99%

“…This trial showed that the index of ventilator-free days was higher in the intervention group than in the control group (7.8 ± 9.7 days versus 3.7 ± 6.4 days, p = 0.044). The use of LUS monitoring for the diagnosis of VAP may improve patient outcomes in comparison with the standard diagnostic strategy [69]. However, larger studies are needed to confirm the potential benefit of LUS for these patients.…”

Section: Clinical Studies For the Assessment Of Ventilator-associated Pneumoniamentioning

confidence: 99%

Point-of-care lung ultrasound for the assessment of pneumonia: a narrative review in the COVID-19 era

et al. 2021

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In the coronavirus disease-2019 (COVID-19) era, point-of-care lung ultrasound (LUS) has attracted increased attention. Prospective studies on LUS for the assessment of pneumonia in adult patients were extensively carried out for more than 10 years before this era. None of these prospective studies attempted to differentiate bacterial and viral pneumonia in adult patients using LUS. The majority of studies considered the LUS examination to be positive if sonographic consolidations or multiple B-lines were observed. Significant differences existed in the accuracy of these studies. Some studies revealed that LUS showed superior sensitivity to chest X-ray. These results indicate that point-of-care LUS has the potential to be an initial imaging modality for the diagnosis of pneumonia. The LUS diagnosis of ventilator-associated pneumonia in intensive care units is more challenging in comparison with the diagnosis of community-acquired pneumonia in emergency departments due to the limited access to the mechanically ventilated patients and the high prevalence of atelectasis. However, several studies have demonstrated that the combination of LUS findings with other clinical markers improved the diagnostic accuracy. In the COVID-19 era, many case reports and small observational studies on COVID-19 pneumonia have been published in a short period. Multiple B-lines were the most common and consistent finding in COVID-19 pneumonia. Serial LUS showed the deterioration of the disease. The knowledge and ideas on the application of LUS in the management of pneumonia that are expected to accumulate in the COVID-19 era may provide us with clues regarding more appropriate management.

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“…Specific ultrasound findings provide useful information for the monitoring of mechanically ventilated patients [ 60 , 67 ]. A complete examination requires only a few minutes and shows high inter-observer agreement even with ultra-portable devices [ 8 – 68 ]. Changes in the LUS score over time may help the assessment of disease progression and of the response to treatments in ARDS patients [ 69 – 72 ].…”

Section: Resultsmentioning

confidence: 99%

“…More recently, quantitative analysis of the LUS score has been proposed to make the interpretation of findings less operator dependent [ 6 ]. VAP-related injuries typically extend from the center to the periphery of the lung; when these lesions reach the subpleural regions, they become identifiable by LUS: a normal A-line pattern with lung sliding is replaced by focal areas of interstitial syndrome, represented by well-spaced B-lines, becoming progressively confluent into subpleural areas of consolidation, where air-bronchograms may be visualized [ 68 ]. LUS could become a tool for the detection of VAP in the ICU, but this application has only been investigated so far by three specific studies [ 6 , 39 , 68 ].…”

Section: Resultsmentioning

confidence: 99%

Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO)

Vetrugno

Mojoli

Cortegiani

et al. 2021

J Anesth Analg Crit Care

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Background To produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit. Methods A modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without invasive mechanical ventilation), positive end expiratory pressure titration, the use of prone position, the early diagnosis of pneumothorax- or ventilator-associated pneumonia, the process of weaning from invasive mechanical ventilation, and the need for radiologic chest imaging. Results A total of 20 statements were produced by the panel. Agreement was reached on 18 out of 20 statements (scoring 7–9; “appropriate”) in the first round of voting, while 2 statements required a second round for agreement to be reached. At the end of the two Delphi rounds, the median score for the 20 statements was 8.5 [IQR 8.9], and the agreement percentage was 100%. Conclusion The Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care produced 20 consensus statements on the use of lung ultrasound in COVID-19 patients admitted to the ICU. This expert consensus strongly suggests integrating lung ultrasound findings in the clinical management of critically ill COVID-19 patients.

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Clinical impact of lung ultrasound monitoring for diagnosis of ventilator associated pneumonia: A diagnostic randomized controlled trial

Cited by 19 publications

References 34 publications

Lung ultrasound score as a tool to monitor disease progression and detect ventilator-associated pneumonia during COVID-19-associated ARDS

Lung ultrasound score as a tool to monitor disease progression and detect ventilator-associated pneumonia during COVID-19-associated ARDS

Point-of-care lung ultrasound for the assessment of pneumonia: a narrative review in the COVID-19 era

Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO)

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