The Role of Lung Ultrasound Monitoring in Early Detection of Ventilator-Associated Pneumonia in COVID-19 Patients: A Retrospective Observational Study

Journal of Clinical Medicine

Nello De Vita¹  Giuseppe Maggio¹  Silvia Bonaiti¹  Silvia Mongodi¹  Francesco Mojoli¹  Alessandro Amatu¹  Catherine Klersy²  Valeria Musella²  Belaid Bouhemad³  Rosanna Vaschetto⁴  Francesco Daverio⁵  Giulia Salve⁵  Gilda Siano⁵  Margherita Cavagnino⁵ 

[1] Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, DEA piano-1, Viale Camillo Golgi, 19, 27100 Pavia, Italy;Clinical Epidemiology and Biometrics, Fondazione IRCCS Policlinico S. Matteo, Viale Camillo Golgi, 19, 27100 Pavia, Italy;Department of Anaesthesiology and Intensive Care, C.H.U. Dijon, BP 77908, CEDEX, 21709 Dijon, France;Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy;Unit of Anaesthesia and Intensive Care, Department of Clinical-Surgical, Diagnostic, and Paediatric Sciences, Università di Pavia, Viale Brambilla, 74, 27100 Pavia, Italy;

关键词: lung ultrasound;    lung monitoring;    ventilator-associated pneumonia;    nosocomial infection;    arborescent air bronchogram;    lung ultrasound score;   

DOI  :  10.3390/jcm11113001

来源: DOAJ

【 摘 要 】

Specific lung ultrasound signs combined with clinical parameters allow for early diagnosis of ventilator-associated pneumonia in the general ICU population. This retrospective cohort study aimed to determine the accuracy of lung ultrasound monitoring for ventilator-associated pneumonia diagnosis in COVID-19 patients. Clinical (i.e., clinical pulmonary infection score) and ultrasound (i.e., presence of consolidation and a dynamic linear–arborescent air bronchogram, lung ultrasound score, ventilator-associated lung ultrasound score) data were collected on the day of the microbiological sample (pneumonia-day) and 48 h before (baseline) on 55 bronchoalveolar lavages of 33 mechanically-ventilated COVID-19 patients who were monitored daily with lung ultrasounds. A total of 26 samples in 23 patients were positive for ventilator-associated pneumonia (pneumonia cases). The onset of a dynamic linear–arborescent air bronchogram was 100% specific for ventilator-associated pneumonia. The ventilator-associated lung ultrasound score was higher in pneumonia-cases (2.5 (IQR 1.0 to 4.0) vs. 1.0 (IQR 1.0 to 1.0); p < 0.001); the lung ultrasound score increased from baseline in pneumonia-cases only (3.5 (IQR 2.0 to 6.0) vs. −1.0 (IQR −2.0 to 1.0); p = 0.0001). The area under the curve for clinical parameters, ventilator-associated pneumonia lung ultrasound score, and lung ultrasound score variations were 0.472, 0.716, and 0.800, respectively. A newly appeared dynamic linear–arborescent air bronchogram is highly specific for ventilator-associated pneumonia in COVID-19 patients. A high ventilator-associated pneumonia lung ultrasound score (or an increase in the lung ultrasound score) orients to ventilator-associated pneumonia.

【 授权许可】

Unknown