title: Lung Ultrasound for Early Diagnosis of Ventilator-Associated Pneumonia.
abstract: 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, no scientific evidence is yet available on whether LUS reliably improves the diagnosis of VAP.
  
  
  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, and dynamic arborescent/linear air bronchogram. We also evaluated the combination of LUS with direct microbiologic examination of endotracheal aspirates (EA). Scores for LUS findings and EA were analyzed in two ways. First, the clinical-LUS score (ventilator-associated pneumonia lung ultrasound score [VPLUS]) was calculated as follows: ≥ 2 areas with subpleural consolidations, 1 point; ≥ 1 area with dynamic arborescent/linear air bronchogram, 2 points; and purulent EA, 1 point. Second, the VPLUS-direct gram stain examination (EAgram) was scored as follows: ≥ 2 areas with subpleural consolidations, 1 point; ≥ 1 area with dynamic arborescent/linear air bronchogram, 2 points; purulent EA, 1 point; and 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 produced 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 0.832 and 0.743, respectively. VPLUS-EAgram ≥ 3 had 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 was a reliable tool for early VAP diagnosis at the bedside.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT02244723; URL: www.clinicaltrials.gov.
authors.affiliation: Réanimation Chirurgicale, Groupe Hospitalier Saint Joseph, Paris, France; First Department of Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Surgery and Anesthesiology, Unit of Anesthesia, Intensive Care and Pain Therapy, University of Pavia, Pavia, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Mongodi
authors.affiliation: First Department of Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Via
authors.affiliation: Réanimation, Centre Hospitalier de l'Université de Montréal, Pavillon Notre-Dame, Montreal, QC, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Girard
authors.affiliation: Réanimation Chirurgicale, Groupe Hospitalier Saint Joseph, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Rouquette
authors.affiliation: Department of Anesthesiology and Critical Care, and Réanimation Polyvalente, Groupe Hospitalier Saint Joseph, Paris, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Misset
authors.affiliation: First Department of Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Surgery and Anesthesiology, Unit of Anesthesia, Intensive Care and Pain Therapy, University of Pavia, Pavia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Braschi
authors.affiliation: First Department of Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Surgery and Anesthesiology, Unit of Anesthesia, Intensive Care and Pain Therapy, University of Pavia, Pavia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mojoli
authors.affiliation: Réanimation Chirurgicale, Groupe Hospitalier Saint Joseph, Paris, France. Electronic address: belaid_bouhemad@hotmail.com.
authors.forename: Bélaïd
authors.initials: B
authors.lastname: Bouhemad
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001995:Bronchography; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D014463:Ultrasonography
keywords: diagnostic imaging; echo; ventilator-associated pneumonia