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Accuracy and Applications of Lung Ultrasound to Diagnose Ventilator-Associated Pneumonia: A Systematic Review.
J Intensive Care Med. 2018 Aug; 33(8):447-455.JI

Abstract

BACKGROUND

Lung ultrasound (LUS) is an accurate tool to diagnose community-acquired pneumonia. However, it is not yet an established tool to diagnose ventilator-associated pneumonia (VAP).

PURPOSE

To assess the evidence about LUS in the diagnosis of VAP, we conducted a systematic review of the literature.

METHODS

We searched PubMed, Embase, Scopus, Web of Science, and LILACS. Two researchers independently selected the studies that met the inclusion criteria. Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the quality of the studies. In a qualitative synthesis, 3 questions guided the review: Q1. What are the sonographic signs of VAP? Q2. How can LUS be combined with others tests or signs of VAP? Q3. What is the role of LUS in VAP screening?

MAIN RESULTS

Three studies (n = 377 patients) with different designs were included. In terms of Q1, the 3 studies assessed the accuracy of sonographic consolidations. In patients suspected for VAP, lobar or hemilobar consolidation alone was not sufficient to diagnose VAP but seems useful to exclude it. The most useful signs were small subpleural consolidations (sensitivity: 81%; specificity: 41%) and dynamic air bronchograms (sensitivity: 44%; specificity: 81%). Two studies were assessed for Q2, when the 2 signs above were included in a clinical score (Ventilator-associated Pneumonia Lung Ultrasound Score associated with quantitative culture of endotracheal aspirate-VPLUS-EAquant), the accuracy was amplified (sensitivity: 48% and specificity: 97% for score ≥4; sensitivity: 78% and specificity: 77% for score ≥3 points). Finally, regarding Q3, no studies have assessed the use of LUS in screening of VAP.

CONCLUSION

Small subpleural consolidations and dynamic air bronchograms were the most useful sonographic signs to diagnose VAP in suspected patients. Clinical scores including LUS had better diagnosis accuracy than LUS alone. There are no data on LUS for VAP screening.

Authors+Show Affiliations

1 Emergency Department of University Hospital, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil. 2 Intensive Care Unit of Nereu Ramos Hospital, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.3 Intensive Care Unit of University Hospital, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.4 Department of Clinical Medicine, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil. 5 Graduate Program in Medical Sciences, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

29084483

Citation

Staub, Leonardo Jönck, et al. "Accuracy and Applications of Lung Ultrasound to Diagnose Ventilator-Associated Pneumonia: a Systematic Review." Journal of Intensive Care Medicine, vol. 33, no. 8, 2018, pp. 447-455.
Staub LJ, Biscaro RRM, Maurici R. Accuracy and Applications of Lung Ultrasound to Diagnose Ventilator-Associated Pneumonia: A Systematic Review. J Intensive Care Med. 2018;33(8):447-455.
Staub, L. J., Biscaro, R. R. M., & Maurici, R. (2018). Accuracy and Applications of Lung Ultrasound to Diagnose Ventilator-Associated Pneumonia: A Systematic Review. Journal of Intensive Care Medicine, 33(8), 447-455. https://doi.org/10.1177/0885066617737756
Staub LJ, Biscaro RRM, Maurici R. Accuracy and Applications of Lung Ultrasound to Diagnose Ventilator-Associated Pneumonia: a Systematic Review. J Intensive Care Med. 2018;33(8):447-455. PubMed PMID: 29084483.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Accuracy and Applications of Lung Ultrasound to Diagnose Ventilator-Associated Pneumonia: A Systematic Review. AU - Staub,Leonardo Jönck, AU - Biscaro,Roberta Rodolfo Mazzali, AU - Maurici,Rosemeri, Y1 - 2017/10/30/ PY - 2017/11/1/pubmed PY - 2018/11/21/medline PY - 2017/11/1/entrez KW - diagnostic accuracy KW - intensive care unit KW - lung ultrasound KW - mechanical ventilation KW - nosocomial infections KW - ventilator-associated pneumonia SP - 447 EP - 455 JF - Journal of intensive care medicine JO - J Intensive Care Med VL - 33 IS - 8 N2 - BACKGROUND: Lung ultrasound (LUS) is an accurate tool to diagnose community-acquired pneumonia. However, it is not yet an established tool to diagnose ventilator-associated pneumonia (VAP). PURPOSE: To assess the evidence about LUS in the diagnosis of VAP, we conducted a systematic review of the literature. METHODS: We searched PubMed, Embase, Scopus, Web of Science, and LILACS. Two researchers independently selected the studies that met the inclusion criteria. Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the quality of the studies. In a qualitative synthesis, 3 questions guided the review: Q1. What are the sonographic signs of VAP? Q2. How can LUS be combined with others tests or signs of VAP? Q3. What is the role of LUS in VAP screening? MAIN RESULTS: Three studies (n = 377 patients) with different designs were included. In terms of Q1, the 3 studies assessed the accuracy of sonographic consolidations. In patients suspected for VAP, lobar or hemilobar consolidation alone was not sufficient to diagnose VAP but seems useful to exclude it. The most useful signs were small subpleural consolidations (sensitivity: 81%; specificity: 41%) and dynamic air bronchograms (sensitivity: 44%; specificity: 81%). Two studies were assessed for Q2, when the 2 signs above were included in a clinical score (Ventilator-associated Pneumonia Lung Ultrasound Score associated with quantitative culture of endotracheal aspirate-VPLUS-EAquant), the accuracy was amplified (sensitivity: 48% and specificity: 97% for score ≥4; sensitivity: 78% and specificity: 77% for score ≥3 points). Finally, regarding Q3, no studies have assessed the use of LUS in screening of VAP. CONCLUSION: Small subpleural consolidations and dynamic air bronchograms were the most useful sonographic signs to diagnose VAP in suspected patients. Clinical scores including LUS had better diagnosis accuracy than LUS alone. There are no data on LUS for VAP screening. SN - 1525-1489 UR - https://www.unboundmedicine.com/medline/citation/29084483/Accuracy_and_Applications_of_Lung_Ultrasound_to_Diagnose_Ventilator_Associated_Pneumonia:_A_Systematic_Review_ L2 - http://journals.sagepub.com/doi/full/10.1177/0885066617737756?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -