The Application of Pulmonary Ultrasound in Neonatal Ventilator-Associated Pneumonia

Abstract

This study explored the application value of lung ultrasound (LUS) in neonatal ventilator-associated pneumonia (NVAP). In this study, 122 newborns suspected of NVAP were treated in the NICU of Liaocheng People’s Hospital between July 1, 2020, and July 1, 2021. Of these, 115 were clinically diagnosed with NVAP. The diagnostic value of LUS for NVAP was determined by comparing the different signs of LUS and chest X-ray (CXR). The confirmed cases were divided into the failure and success groups according to the first ventilator weaning test results. The consistency between the results of LUS and CXR and the actual test results was compared between the two groups. Before treatment, the LUS findings of the confirmed cases showed a lung consolidation with air bronchogram sign (111/115), alveolar-interstitial syndrome (113/115), pleural effusion (12/115), pleural line abnormalities (114/115), and lung pulse (15/115). CXR showed 109 cases of pneumonia. Taking the clinical diagnosis of VAP as the gold standard, the lung consolidation with air bronchogram sign on LUS had a higher sensitivity, specificity, and accuracy for the diagnosis of NVAP than those of other LUS and CXR findings and showed better consistency with the clinical diagnosis (AUC = 0.983, kappa value = 0.761, p < 0.05). After treatment, the 115 cases were divided into two groups according to the results of the first weaning from ventilation: the failed group (19 cases) and the successful group (96 cases). The lung consolidation with air bronchogram sign was used as the positive diagnostic standard of ultrasound. The sensitivity and specificity of LUS (94.7 and 89.6%, respectively) in evaluating the outcome of weaning from the ventilator of pneumonia were higher than those of CXR (73.7 and 84.4%, respectively). Additionally, the consistency of the LUS findings with the weaning results was higher than that of CXR (AUC = 0.922, kappa value = 0.709, p < 0.05). Therefore, compared with CXR, LUS has a higher value in diagnosing NVAP and can better predict the results of the ventilator off-line test. LUS can replace CXR as the first imaging examination for NVAP.

No Critical Ultrasound, No Life: The Value of Point-of Care Critical Ultrasound in the Rescue of Critically Ill Infants

“…After admission, the physical examination, arterial blood gas analysis, routine blood tests, and coagulation function tests all gave normal results. Lung ultrasound (LUS) showed bilateral confluent B-lines, alveolar-interstitial syndrome, and subpleural consolidation with air bronchograms in some intercostal spaces, consistent with ultrasound image characteristics of neonatal pneumonia [6][7][8] (Figure 2A). The brain ultrasound images and cerebral hemodynamic monitoring were normal (Figure 3).…”

Diagnostic Accuracy of Lung Ultrasound in Neonatal Diseases: A Systematized Review

“…Jiang et al [ 41 ] conducted a study to compare CXR and LUS in 115 patients with ventilator-associated pneumonia (VAP). LUS findings of the confirmed cases showed a lung consolidation with an air bronchogram sign (111/115), alveolar-interstitial syndrome (113/115), pleural effusion (12/115), pleural line abnormalities (114/115), and lung pulse (15/115).…”

“…We found a meta-analysis assessing the role of LUS in diagnosing pneumonia in children < 16 years of age (a small number of infants included) [ 42 ]. Other smaller studies showed that LUS has excellent sensitivity and specificity for the diagnosis of severe pneumonia [ 39 ] and is more accurate than CXR for the diagnosis of VAP [ 41 ]. Moreover, some authors reported that adding LUS data to clinical features is more accurate than adding CXR data for the diagnosis of VAP [ 40 ].…”

Accuracy of Thoracic Ultrasonography for the Diagnosis of Pediatric Pneumonia: A Systematic Review and Meta-Analysis

“…The detailed characteristics of these studies are also presented in Table 2. Two studies were conducted in North America [14,29], sixteen in Europe [11][12][13]15,16,[18][19][20][21][22][23][24][26][27][28]35], seven in Asia [17,25,30,[32][33][34]36], and one in Africa [31]. The study subjects were mainly infants, children, and adolescents, except for two studies that included newborns [17,32].…”

“…Two studies were conducted in North America [14,29], sixteen in Europe [11][12][13]15,16,[18][19][20][21][22][23][24][26][27][28]35], seven in Asia [17,25,30,[32][33][34]36], and one in Africa [31]. The study subjects were mainly infants, children, and adolescents, except for two studies that included newborns [17,32]. A total of 23 studies involved pediatric patients admitted to either the wards or emergency departments, while three studies [15,17,32] involved patients in ICU (two studies in NICU and one in PICU).…”