Lung Ultrasound Combined With Procalcitonin for a Diagnosis of Ventilator-Associated Pneumonia

Lung ultrasound is a valuable imaging tool in the diagnosis of community-acquired pneumonia. However, its diagnostic accuracy in ventilator-associated pneumonia (VAP) has not been fully investigated. The aim of this study was to evaluate the diagnostic performance of the combination of a lung ultras...

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Published in:	Respiratory care Vol. 64; no. 5; p. 519
Main Authors:	Zhou, Juandi, Song, Jia, Gong, Shijin, Hu, Weihang, Wang, Minjia, Xiao, Aibing, Zhang, Cong, Dong, Zhouzhou
Format:	Journal Article
Language:	English
Published:	United States 01.05.2019
Subjects:	Aged Aged, 80 and over Area Under Curve False Negative Reactions False Positive Reactions Female Humans Lung - diagnostic imaging Male Middle Aged Pneumonia, Ventilator-Associated - blood Pneumonia, Ventilator-Associated - diagnostic imaging Predictive Value of Tests Procalcitonin - blood Prospective Studies ROC Curve Tomography, X-Ray Computed Ultrasonography ventilator-associated diagnosis procalcitonin pneumonia lung ultrasound
ISSN:	1943-3654, 1943-3654
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Abstract	Lung ultrasound is a valuable imaging tool in the diagnosis of community-acquired pneumonia. However, its diagnostic accuracy in ventilator-associated pneumonia (VAP) has not been fully investigated. The aim of this study was to evaluate the diagnostic performance of the combination of a lung ultrasound with procalcitonin (PCT) in mechanically ventilated subjects with symptoms suggestive of pneumonia. A prospective study of 124 subjects with suspected VAP in 2 multidisciplinary ICUs was conducted between December 2016 and October 2017. Lower respiratory tract specimens were collected from all the subjects at enrollment and on the following 3 d. PCT assays were performed within 1 h of enrollment. Lung ultrasound and then computed tomography of the chest were performed within 24 h to detect lung consolidations. The subjects were divided into VAP and non-VAP groups according to the results of a computed tomography of the chest and semi-quantitative culture of the lower respiratory tract sample. A total of 124 subjects were included (48 in the VAP group and 76 in the non-VAP group). A positive lung ultrasound result combined with PCT of ≥0.25 ng/mL diagnosed VAP, with a sensitivity and specificity of 81.3 and 85.5%, respectively. The area under the receiver operating characteristic curve was significantly higher for lung ultrasound combined with PCT than for a white blood cell count, PCT, C-reactive protein, or Clinical Pulmonary Infection Score alone. A combination of lung ultrasound and PCT was accurate in the diagnosis of VAP. Lung ultrasound is a useful lung-imaging tool to assist VAP diagnosis.
AbstractList	Lung ultrasound is a valuable imaging tool in the diagnosis of community-acquired pneumonia. However, its diagnostic accuracy in ventilator-associated pneumonia (VAP) has not been fully investigated. The aim of this study was to evaluate the diagnostic performance of the combination of a lung ultrasound with procalcitonin (PCT) in mechanically ventilated subjects with symptoms suggestive of pneumonia. A prospective study of 124 subjects with suspected VAP in 2 multidisciplinary ICUs was conducted between December 2016 and October 2017. Lower respiratory tract specimens were collected from all the subjects at enrollment and on the following 3 d. PCT assays were performed within 1 h of enrollment. Lung ultrasound and then computed tomography of the chest were performed within 24 h to detect lung consolidations. The subjects were divided into VAP and non-VAP groups according to the results of a computed tomography of the chest and semi-quantitative culture of the lower respiratory tract sample. A total of 124 subjects were included (48 in the VAP group and 76 in the non-VAP group). A positive lung ultrasound result combined with PCT of ≥0.25 ng/mL diagnosed VAP, with a sensitivity and specificity of 81.3 and 85.5%, respectively. The area under the receiver operating characteristic curve was significantly higher for lung ultrasound combined with PCT than for a white blood cell count, PCT, C-reactive protein, or Clinical Pulmonary Infection Score alone. A combination of lung ultrasound and PCT was accurate in the diagnosis of VAP. Lung ultrasound is a useful lung-imaging tool to assist VAP diagnosis. Lung ultrasound is a valuable imaging tool in the diagnosis of community-acquired pneumonia. However, its diagnostic accuracy in ventilator-associated pneumonia (VAP) has not been fully investigated. The aim of this study was to evaluate the diagnostic performance of the combination of a lung ultrasound with procalcitonin (PCT) in mechanically ventilated subjects with symptoms suggestive of pneumonia.BACKGROUNDLung ultrasound is a valuable imaging tool in the diagnosis of community-acquired pneumonia. However, its diagnostic accuracy in ventilator-associated pneumonia (VAP) has not been fully investigated. The aim of this study was to evaluate the diagnostic performance of the combination of a lung ultrasound with procalcitonin (PCT) in mechanically ventilated subjects with symptoms suggestive of pneumonia.A prospective study of 124 subjects with suspected VAP in 2 multidisciplinary ICUs was conducted between December 2016 and October 2017. Lower respiratory tract specimens were collected from all the subjects at enrollment and on the following 3 d. PCT assays were performed within 1 h of enrollment. Lung ultrasound and then computed tomography of the chest were performed within 24 h to detect lung consolidations. The subjects were divided into VAP and non-VAP groups according to the results of a computed tomography of the chest and semi-quantitative culture of the lower respiratory tract sample.METHODSA prospective study of 124 subjects with suspected VAP in 2 multidisciplinary ICUs was conducted between December 2016 and October 2017. Lower respiratory tract specimens were collected from all the subjects at enrollment and on the following 3 d. PCT assays were performed within 1 h of enrollment. Lung ultrasound and then computed tomography of the chest were performed within 24 h to detect lung consolidations. The subjects were divided into VAP and non-VAP groups according to the results of a computed tomography of the chest and semi-quantitative culture of the lower respiratory tract sample.A total of 124 subjects were included (48 in the VAP group and 76 in the non-VAP group). A positive lung ultrasound result combined with PCT of ≥0.25 ng/mL diagnosed VAP, with a sensitivity and specificity of 81.3 and 85.5%, respectively. The area under the receiver operating characteristic curve was significantly higher for lung ultrasound combined with PCT than for a white blood cell count, PCT, C-reactive protein, or Clinical Pulmonary Infection Score alone.RESULTSA total of 124 subjects were included (48 in the VAP group and 76 in the non-VAP group). A positive lung ultrasound result combined with PCT of ≥0.25 ng/mL diagnosed VAP, with a sensitivity and specificity of 81.3 and 85.5%, respectively. The area under the receiver operating characteristic curve was significantly higher for lung ultrasound combined with PCT than for a white blood cell count, PCT, C-reactive protein, or Clinical Pulmonary Infection Score alone.A combination of lung ultrasound and PCT was accurate in the diagnosis of VAP. Lung ultrasound is a useful lung-imaging tool to assist VAP diagnosis.CONCLUSIONSA combination of lung ultrasound and PCT was accurate in the diagnosis of VAP. Lung ultrasound is a useful lung-imaging tool to assist VAP diagnosis.
Author	Xiao, Aibing Zhang, Cong Dong, Zhouzhou Song, Jia Hu, Weihang Gong, Shijin Zhou, Juandi Wang, Minjia
Author_xml	– sequence: 1 givenname: Juandi surname: Zhou fullname: Zhou, Juandi organization: Department of General Surgery, Zhejiang Hospital, Hangzhou, China – sequence: 2 givenname: Jia surname: Song fullname: Song, Jia email: songjia9a@163.com organization: Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, China. songjia9a@163.com – sequence: 3 givenname: Shijin surname: Gong fullname: Gong, Shijin organization: Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, China – sequence: 4 givenname: Weihang surname: Hu fullname: Hu, Weihang organization: Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, China – sequence: 5 givenname: Minjia surname: Wang fullname: Wang, Minjia organization: Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, China – sequence: 6 givenname: Aibing surname: Xiao fullname: Xiao, Aibing organization: Department of Critical Care Medicine, Taizhou Municipal Hospital, Taizhou, China – sequence: 7 givenname: Cong surname: Zhang fullname: Zhang, Cong organization: Zhejiang Chinese Medical University, Hangzhou, China – sequence: 8 givenname: Zhouzhou surname: Dong fullname: Dong, Zhouzhou organization: Department of Critical Care Medicine, Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, China
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SubjectTerms	Aged Aged, 80 and over Area Under Curve False Negative Reactions False Positive Reactions Female Humans Lung - diagnostic imaging Male Middle Aged Pneumonia, Ventilator-Associated - blood Pneumonia, Ventilator-Associated - diagnostic imaging Predictive Value of Tests Procalcitonin - blood Prospective Studies ROC Curve Tomography, X-Ray Computed Ultrasonography
Title	Lung Ultrasound Combined With Procalcitonin for a Diagnosis of Ventilator-Associated Pneumonia
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