Lung ultrasound: a promising tool to monitor ventilator-associated pneumonia in critically ill patients

Guyi Wang, Xiaoying Ji, Yongshan Xu, Xudong Xiang, Guyi Wang, Xiaoying Ji, Yongshan Xu, Xudong Xiang

Abstract

Ventilator-associated pneumonia (VAP) is the most frequent intensive care unit (ICU)-acquired infection that is independently associated with mortality. Accurate diagnosis and timely treatment have been shown to improve the prognosis of VAP. Chest X-ray or computed tomography imaging are used for conventional assessment of VAP, but these methods are impractical for real-time measurement in critical patients. Therefore, lung ultrasound (LUS) has been increasingly used for the assessment of VAP in the ICU. Traditionally, LUS has seemed unsuitable for the detection of lung parenchyma owing to the high acoustic impedance of air; however, the fact that the reflection and reverberation in the detection region of the ultrasound reflect the underlying pathology of lung diseases has led to the increased use of ultrasound imaging as a standard of care supported by evidence-based and expert consensus in the ICU. Considering that any type of pneumonia causes air volume changes in the lungs, accumulating evidence has shown that LUS effectively measures the presence of VAP as well as dynamic changes in VAP. This review offers evidence for ultrasound as a noninvasive, easily repeatable, and bedside means to assess VAP; in addition, it establishes a protocol for qualitative and quantitative monitoring of VAP.

Trial registration: ClinicalTrials.gov NCT02244723.

Keywords: Intensive care unit; Lung ultrasound; Ventilator-associated pneumonia.

Figures

Fig. 1
Fig. 1
Basic characteristic sonographic patterns. The basic characteristic sonographic patterns are illustrated (left) and described according to distinctive features (right). a A lines are characteristic lines parallel to the pleural line. b B lines are long, vertical, hyperechoic, and dynamic lines originating from the pleural line, moving with lung sliding. c Lung consolidation is a tissue-like echotexture of the lung with or without a bronchogram. d The lung point is a point of contact between normal lung sliding (sandy sign) and the absence of lung sliding (barcode sign). e Pleural effusion is an echo-free zone (P tissue-like echotexture of the lung, E pleural effusion)
Fig. 2
Fig. 2
Sequential interpretation of the LUS protocol for detecting VAP. This is a schematic, simplified decision tree of the VAP protocol. The basic steps include the identification of landmarks, longitudinal scans, focal examination, and overall lung integration. The identification of landmarks is helpful for standardized and reproducible analyses. The longitudinal scans mainly provide a preliminary view of the sonographic patterns. The focal examination mainly reveals the characteristic features of a lesion. The overall lung integration enables the translation of all data into a possible clinical decision and monitoring plan. AIS alveolar interstitial syndromes, VAP ventilator-associated pneumonia

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