Transthoracic Ultrasound in the Diagnosis and Follow-up of Ventilator Associated Pneumonia

Transthoracic Ultrasound in the Diagnosis and Follow-up of Ventilator Associated Pneumonia

To evaluate the sensitivity, specificity and diagnostic accuracy of bedside transthoracic ultrasound examination in the diagnosis and follow up of ventilator associated pneumonia.

VAP is the most frequent hospital-acquired infection in intensive care units. Depending on the diagnostic criteria used, its incidence ranges from 5% to 67%. The risk of acquiring VAP is 3% per day during the first 5 days on mechanical ventilation, and it is decreased to 1% per day for the following days.

VAP is suspected when subject shows high grade fever, increase in leukocyte count, change in color of sputum and tachypnea. It's a leading cause of mortality in 15- 65% of the cases.

Serial chest x-ray for diagnosis and follow up, done at time of diagnosis, after 5 days and after 10 days. Chest radiography is consistently carried out after LUS , LUS is done every other day, measuring the largest area of consolidation according to the intercostal space and direction of the probe . Chest radiography is read by two physicians.

Inclusion Criteria:

• Mechanical ventilation for at least 48 hours.
• New or evolving infiltrate on chest radiograph (CXR).
• Clinical pulmonary infection score more than or equal 6

Exclusion Criteria:

• Patients who are less than 18 years old.
• Patients who have evidence of pneumonia before or prior to being mechanically ventilated.
• Patients with pulmonary infarction.