Emergence of Alveolar Consolidations in Serial Lung Ultrasound and Diagnosis of Ventilator-Associated Pneumonia

2019 ◽  
pp. 088506661989427 ◽  
Author(s):  
Leonardo Jönck Staub ◽  
Roberta Rodolfo Mazzali Biscaro ◽  
Rosemeri Maurici
Keyword(s):  
Mechanical Ventilation ◽  
Confidence Interval ◽  
Diagnostic Tool ◽  
Lung Ultrasound ◽  
Lung Parenchyma ◽  
Diagnostic Value ◽  
Clinical Suspicion ◽  
Ventilator Associated Pneumonia ◽  
Endotracheal Aspirate

Background: Lung ultrasound (LUS) has been reported as a promising diagnostic tool for ventilator-associated pneumonia (VAP), but patients with previous lung parenchyma commitment have been not studied. Purpose: To evaluate whether the emergence of sonographic consolidations, rather than their presence, can improve the VAP diagnosis in a sample including patients with previous lung parenchyma diseases. Methods: Patients who completed 48 hours of mechanical ventilation were prospectively studied with daily LUS examinations. We checked the emergence of different consolidation types on the eve and on the day of a clinical suspicion of VAP. We elaborated an algorithm considering, sequentially, the emergence of (1) subpleural consolidations in anterior lung regions on the eve of suspicion; (2) lobar/sublobar consolidation in anterior lung regions on the day of suspicion; (3) lobar/sublobar consolidation with dynamic air bronchograms on the day of suspicion; and (4) any other lobar/sublobar consolidation on the day of suspicion in association with a positive Gram smear of endotracheal aspirate. Results: Of the 188 included patients, 60 were suspected and 33 confirmed VAP. The presence of sonographic consolidations at the clinical suspicion had no diagnostic value for VAP. The emergence of subpleural consolidations in anterior lung regions on the eve of suspicion had specificity of 95% (95% confidence interval [CI], 79%-99%). The emergence of lobar/sublobar consolidations in anterior lung regions on the day of suspicion had specificity of 100% (95% CI, 87%-100%). The emergence of lobar/sublobar consolidations with dynamic air bronchograms on the day of suspicion had specificity of 96% (95% CI, 81%-99%). Finally, the proposed algorithm had sensitivity of 63% (95% CI, 46%-77%) and specificity of 85% (95% CI, 67%-94%) for VAP. Conclusions: The presence of sonographic consolidations was not accurate for VAP when patients with previous lung parenchyma commitment were included. However, serial LUS examinations detected the emergence of specific signs of VAP.

scholarly journals Role of colonizers and value of routine surveillance culture of endotracheal aspirate of patients in the diagnosis of ventilator associated pneumonia

2020 ◽  
Vol 11 (6) ◽  
pp. 106-112
Author(s):  
Sana Siddique ◽  
Fareya Haider ◽  
Sharique Ahmad ◽  
Khalid Iqbal ◽  
Mastan Singh
Keyword(s):  
Mechanical Ventilation ◽  
Pseudomonas Aeruginosa ◽  
Tertiary Care ◽  
Causative Organism ◽  
Klebsiella Pneumonia ◽  
Surveillance Culture ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Endotracheal Aspirate

Background: Ventilator associated pneumonia (VAP) is considered to be second most common nosocomial infection patients requiring critical care. Aims and Objective: The present study was conducted to study the role of colonizers and importance of surveillance cultures of endotracheal aspirate (ETA) in the diagnosis of ventilator associated pneumonia in a tertiary care hospital in Lucknow. Materials and Methods: An observational longitudinal study was conducted over a period of 2 years, on a total of 210 critically ill patients on mechanical ventilation for >48hrs, to identify the common isolates from ETA culture. Follow up of such patients was done to know the role of these isolates in causation of Ventilator Associated Pneumonia (VAP). Patients fulfilling both clinical Pulmonary infection score (CPIS>6) and microbiological criteria were diagnosed as VAP. Those microorganisms with a colony count of less<105 cfu/ml in both the patients with VAP and those without VAP were considered as colonizers. Results: Klebseilla pneumonia (46.2%), Pseudomonas aeruginosa (16.2%) and E.coli (13.8%) were found be the commonest colonisers followed by Acinetobacterbaumanii (8.6%), Citrobacterkoseri (3.8%), Coagulase Negative Staphylococci (2.9%), Staphylococcus aureus (2.4%) and Proteus vulgaris (1%). Of the total patients 28 developed VAP out of which 21 had late onset VAP and 7 had early onset VAP. Among the VAP positive patients the causative organism was Klebsiella pneumonia (53.6%) for majority of cases followed by Pseudomonas aeruginosa (21.4%) and Acinetobacter baumanii (17.9%). Conclusion: Prolonged duration of mechanical ventilation increased the chances of colonization by MDR microorganisms leading to nosocomial or Hospital acquired infections (HAI) such as VAP which in turn lead to increased rate of morbidity and mortality. VAP considered to be a leading cause of HAI, routine quantitative surveillance culture of ETA(endotracheal aspirate) will allow prospectively to determine prevalence and progression of  colonization in lower respiratory tract, so that strict and prompt preventive measures can be taken rather than cure.

scholarly journals DETECTION OF BACTERIA CAUSES VENTILATOR ASSOCIATED PNEUMONIA WITH BRONCHOALVEOLAR LAVAGE CULTURE AND ENDOTRACHEAL ASPIRATE CULTURE

2019 ◽  
Vol 26 (1) ◽  
pp. 40
Author(s):  
Hairiah Asty
Keyword(s):  
Antibiotic Resistance ◽  
Bronchoalveolar Lavage ◽  
Diagnostic Tool ◽  
Ventilator Associated Pneumonia ◽  
Endotracheal Aspirate ◽  
Sensitivity Testing ◽  
Cross Sectional ◽  
Non Invasive ◽  
Identification Of Bacteria ◽  
Bacterial Sensitivity

Ventilator associated pneumonia (VAP) is the most common hospital infection in ICU. Proper and prompt diagnosis and treatment with adequate antibiotics can reduce the high mortality rate, and prevent complications and antibiotic resistance. Invasive methods, such as bronchoalveolar lavage can make a more accurate diagnosis and help with the choice of antibiotics, but require lung experts. While non-invasive methods, such as endotracheal aspirate can be done faster with less complications. The aim of the study was to determine the pattern of bacterial and bacterial sensitivity to bronchoalveolar lavage and endotracheal fluid. This was an observational study with cross-sectional approaches performed at the Intensive Care Unit of RSUP H. Adam Malik Medan, in August 2017 - February 2018. The sample of  23 patients  who met the criteria and was suspected with VAP was carried out by taking endotracheal aspirate and bronchoalveolar lavage. The samples obtained were culture and sensitivity test using BD Phoenix. There was bacteria pattern had compatibility at moderate levels and there was sensitivity and antibiotic resistance were not significantly different from bronchoalveolar cultures and endotracheal aspirate cultures. Endotracheal aspirate culture has a sensitivity of 78.9% and a specificity of  75% for diagnose VAP. Information on the identification of bacteria and sensitivity testing in patients with suspected VAP is required using appropriate sampling techniques. There were no significant differences between bronchoalveolar lavage culture and endotracheal aspirate culture to diagnosing VAP. Endotracheal aspirate culture is a non invasive diagnostic tool that can be used as an alternative diagnostic tool in patients with suspected VAP.

Lung ultrasound in blunt chest trauma: A clinical review

Ultrasound ◽  
2021 ◽  
pp. 1742271X2199460
Author(s):  
Serena Rovida ◽  
Daniele Orso ◽  
Salman Naeem ◽  
Luigi Vetrugno ◽  
Giovanni Volpicelli
Keyword(s):  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Lung Ultrasound ◽  
Lung Parenchyma ◽  
Trauma Patients ◽  
Minor Trauma ◽  
Major Life ◽  
Diagnostic Modality ◽  
Life Threatening ◽  
Sternal Fractures

Introduction Bedside lung sonography is recognized as a reliable diagnostic modality in trauma settings due to its ability to detect alterations both in lung parenchyma and in pleural cavities. In severe blunt chest trauma, lung ultrasound can identify promptly life-threatening conditions which may need direct intervention, whereas in minor trauma, lung ultrasound contributes to detection of acute pathologies which are often initially radio-occult and helps in the selection of those patients that might need further investigation. Topic Description We did a literature search on databases EMBASE, PubMed, SCOPUS and Google Scholar using the terms ‘trauma’, ‘lung contusion’, ‘pneumothorax’, ‘hemothorax’ and ‘lung ultrasound’. The latest articles were reviewed and this article was written using the most current and validated information. Discussion Lung ultrasound is quite accurate in diagnosing pneumothorax by using a combination of four sonographic signs; absence of lung sliding, B-lines, lung pulse and presence of lung point. It provides a rapid diagnosis in hemodynamically unstable patients. Lung contusions and hemothorax can be diagnosed and assessed with lung ultrasound. Ultrasound is also very useful for evaluating rib and sternal fractures and for imaging the pericardium for effusion and tamponade. Conclusion Bedside lung ultrasound can lead to rapid and accurate diagnosis of major life-threatening pathologies in blunt chest trauma patients.

scholarly journals Tocilizumab Improves the Prognosis of COVID-19 in Patients with High IL-6

2021 ◽  
Vol 10 (8) ◽  
pp. 1583
Author(s):  
Robert Flisiak ◽  
Jerzy Jaroszewicz ◽  
Magdalena Rogalska ◽  
Tadeusz Łapiński ◽  
Aleksandra Berkan-Kawińska ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Mechanical Ventilation ◽  
Confidence Interval ◽  
Clinical Improvement ◽  
Interleukin 6 ◽  
Death Rate ◽  
Treatment Effectiveness ◽  
Therapeutic Option ◽  
Oxygen Supplementation ◽  
End Points

Despite direct viral effect, the pathogenesis of coronavirus disease 2019 (COVID-19) includes an overproduction of cytokines including interleukin 6 (IL-6). Therefore, tocilizumab (TOC), a monoclonal antibody against IL-6 receptors, was considered as a possible therapeutic option. Patients were selected from the SARSTer database, containing 2332 individuals with COVID-19. Current study included 825 adult patients with moderate to severe course. Analysis was performed in 170 patients treated with TOC and 655 with an alternative medication. The end-points of treatment effectiveness were death rate, need for mechanical ventilation, and clinical improvement. Patients treated with TOC were balanced compared to non-TOC regarding gender, age, BMI, and prevalence of coexisting conditions. Significant effect of TOC on death was demonstrated in patients with baseline IL-6 > 100 pg/mL (hazard ratio [HR]: 0.21, 95% confidence interval [CI]: 0.08–0.57). The best effectiveness of TOC was achieved in patients with a combination of baseline IL-6 > 100 pg/mL and either SpO2 ≤ 90% (HR: 0.07) or requiring oxygen supplementation (HR: 0.18). Tocilizumab administration in COVID-19 reduces mortality and speeds up clinical improvement in patients with a baseline concentration of IL-6 > 100 pg/mL, particularly if they need oxygen supplementation owing to the lower value of SpO2 ≤ 90%.

A Ventilator-associated Pneumonia Prediction Model in Patients With Acute Respiratory Distress Syndrome

2020 ◽  
Vol 71 (Supplement_4) ◽  
pp. S400-S408
Author(s):  
Zongsheng Wu ◽  
Yao Liu ◽  
Jingyuan Xu ◽  
Jianfeng Xie ◽  
Shi Zhang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Neuromuscular Blocking ◽  
Calibration Plot ◽  
Binary Logistic Regression Analysis ◽  
Ventilator Associated Pneumonia ◽  
Mechanical Ventilation Duration

Abstract Background Mechanical ventilation is crucial for acute respiratory distress syndrome (ARDS) patients and diagnosis of ventilator-associated pneumonia (VAP) in ARDS patients is challenging. Hence, an effective model to predict VAP in ARDS is urgently needed. Methods We performed a secondary analysis of patient-level data from the Early versus Delayed Enteral Nutrition (EDEN) of ARDSNet randomized controlled trials. Multivariate binary logistic regression analysis established a predictive model, incorporating characteristics selected by systematic review and univariate analyses. The model’s discrimination, calibration, and clinical usefulness were assessed using the C-index, calibration plot, and decision curve analysis (DCA). Results Of the 1000 unique patients enrolled in the EDEN trials, 70 (7%) had ARDS complicated with VAP. Mechanical ventilation duration and intensive care unit (ICU) stay were significantly longer in the VAP group than non-VAP group (P &lt; .001 for both) but the 60-day mortality was comparable. Use of neuromuscular blocking agents, severe ARDS, admission for unscheduled surgery, and trauma as primary ARDS causes were independent risk factors for VAP. The area under the curve of the model was .744, and model fit was acceptable (Hosmer-Lemeshow P = .185). The calibration curve indicated that the model had proper discrimination and good calibration. DCA showed that the VAP prediction nomogram was clinically useful when an intervention was decided at a VAP probability threshold between 1% and 61%. Conclusions The prediction nomogram for VAP development in ARDS patients can be applied after ICU admission, using available variables. Potential clinical benefits of using this model deserve further assessment.

Epidemiology and clinical outcome of ventilator-associated events at a tertiary care hospital from North India

2020 ◽  
pp. 004947552098245
Author(s):  
Pooja Kumari ◽  
Priya Datta ◽  
Satinder Gombar ◽  
Deepak Sharma ◽  
Jagdish Chander
Keyword(s):  
Mechanical Ventilation ◽  
Tertiary Care Hospital ◽  
Late Onset ◽  
Tertiary Care ◽  
Control Measures ◽  
North India ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Infection Control Measures ◽  
Utilisation Rate

The aim of our study was to determine the incidence, microbiological profile, risk factors and outcomes of patients diagnosed with ventilator-associated events in our tertiary care hospital. In this prospective study, intensive care patients put on mechanical ventilation for >48 h were enrolled and monitored daily for ventilator-associated event according to Disease Centre Control guidelines. A ventilator-associated event developed in 33/250 (13.2%); its incidence was 3.5/100 mechanical ventilation days. The device utilisation rate was 0.86, 36.4% of patients had early and 63.6% late-onset ventilator-associated pneumonia whose most common causative pathogen was Acinetobacter sp. (63.6%). Various factors were significantly associated with a ventilator-associated event: male gender, COPD, smoking, >2 underlying diseases, chronic kidney disease and elevated acute physiological and chronic health evaluation II scores. Therefore, stringent implementation of infection control measures is necessary to control ventilator-associated pneumonia in critical care units.

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