Document Detail


Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia.
MedLine Citation:
PMID:  19633538     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To compare lung reaeration measured by bedside chest radiography, lung computed tomography, and lung ultrasound in patients with ventilator-associated pneumonia treated by antibiotics. DESIGN: Computed tomography, chest radiography, and lung ultrasound were performed before (day 0) and 7 days following initiation of antibiotics. SETTING: A 26-bed multidisciplinary intensive care unit in La Pitié-Salpêtrière hospital (University Paris-6). PATIENTS:: Thirty critically ill patients studied over the first 10 days of developing ventilator-associated pneumonia. INTERVENTIONS:: Antibiotic administration. MEASUREMENTS AND MAIN RESULTS: Computed tomography reaeration was measured as the additional volume of gas present within both lungs following 7 days of antimicrobial therapy. Lung ultrasound of the entire chest wall was performed and four entities were defined: consolidation; multiple irregularly spaced B-lines; multiple abutting ultrasound lung "comets" issued from the pleural line or a small subpleural consolidation; normal aeration. For each of the 12 regions examined, ultrasound changes were measured between day 0 and 7 and a reaeration score was calculated. An ultrasound score >5 was associated with a computed tomography reaeration >400 mL and a successful antimicrobial therapy. An ultrasound score <-10 was associated with a loss of computed tomography aeration >400 mL and a failure of antibiotics. A highly significant correlation was found between computed tomography and ultrasound lung reaeration (Rho = 0.85, p < .0001). Chest radiography was inaccurate in predicting lung reaeration. CONCLUSIONS: Lung reaeration can be accurately estimated with bedside lung ultrasound in patients with ventilator-associated pneumonia treated by antibiotics. Lung ultrasound can also detect the failure of antibiotics to reaerate the lung.
Authors:
Bélaïd Bouhemad; Zhi-Hai Liu; Charlotte Arbelot; Mao Zhang; Fabio Ferarri; Morgan Le-Guen; Martin Girard; Qin Lu; Jean-Jacques Rouby
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  38     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-22     Completed Date:  2010-01-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  84-92     Citation Subset:  AIM; IM    
Affiliation:
Réanimation Polyvalente Pierre Viars, Department of Anesthesiology and Critical Care, Hôpital de la Pitié-Salpêtrière Assistance Publique Hôpitaux de Paris, Paris, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anti-Bacterial Agents / therapeutic use*
Cohort Studies
Confidence Intervals
Critical Care
Female
Follow-Up Studies
Humans
Intensive Care Units
Male
Middle Aged
Pneumonia, Ventilator-Associated / drug therapy*,  radiography,  ultrasonography*
Point-of-Care Systems*
Probability
Prospective Studies
Radiography, Thoracic / methods
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Tomography, X-Ray Computed / methods
Treatment Outcome
Ultrasonography, Doppler / methods*
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents
Comments/Corrections
Comment In:
Crit Care Med. 2010 Jan;38(1):308-9   [PMID:  20023475 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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