Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia.
OBJECTIVE
To compare lung reaeration measured by bedside chest radiography, lung computed tomography, and lung ultrasound in patients with ventilator-associated pneumonia treated by antibiotics.


METHODS
Computed tomography, chest radiography, and lung ultrasound were performed before (day 0) and 7 days following initiation of antibiotics.


METHODS
A 26-bed multidisciplinary intensive care unit in La Pitié-Salpêtrière hospital (University Paris-6).


METHODS
: Thirty critically ill patients studied over the first 10 days of developing ventilator-associated pneumonia.


METHODS
: Antibiotic administration.


RESULTS
Computed tomography reaeration was measured as the additional volume of gas present within both lungs following 7 days of antimicrobial therapy. Lung ultrasound of the entire chest wall was performed and four entities were defined: consolidation; multiple irregularly spaced B-lines; multiple abutting ultrasound lung "comets" issued from the pleural line or a small subpleural consolidation; normal aeration. For each of the 12 regions examined, ultrasound changes were measured between day 0 and 7 and a reaeration score was calculated. An ultrasound score >5 was associated with a computed tomography reaeration >400 mL and a successful antimicrobial therapy. An ultrasound score <-10 was associated with a loss of computed tomography aeration >400 mL and a failure of antibiotics. A highly significant correlation was found between computed tomography and ultrasound lung reaeration (Rho = 0.85, p < .0001). Chest radiography was inaccurate in predicting lung reaeration.


CONCLUSIONS
Lung reaeration can be accurately estimated with bedside lung ultrasound in patients with ventilator-associated pneumonia treated by antibiotics. Lung ultrasound can also detect the failure of antibiotics to reaerate the lung.
Bouhemad
Bélaïd
B
Réanimation Polyvalente Pierre Viars, Department of Anesthesiology and Critical Care, Hôpital de la Pitié-Salpêtrière Assistance Publique Hôpitaux de Paris, Paris, France.
Liu
Zhi-Hai
ZH
Arbelot
Charlotte
C
Zhang
Mao
M
Ferarri
Fabio
F
Le-Guen
Morgan
M
Girard
Martin
M
Lu
Qin
Q
Rouby
Jean-Jacques
JJ
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D016001:Confidence Intervals; D003422:Critical Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D019095:Point-of-Care Systems; D011336:Probability; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000379:methods; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods*
D000900:Anti-Bacterial Agents