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Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia*

Bouhemad, Bélaïd MD, PhD; Liu, Zhi-Hai MD; Arbelot, Charlotte MD; Zhang, Mao MD; Ferarri, Fabio MD, PhD; Le-Guen, Morgan MD; Girard, Martin MD; Lu, Qin MD, PhD; Rouby, Jean-Jacques MD, PhD

doi: 10.1097/CCM.0b013e3181b08cdb
Clinical Investigations

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.

From the Réanimation Polyvalente Pierre Viars, Department of Anesthesiology and Critical Care, Hôpital de la Pitié-Salpêtrière Assistance Publique Hôpitaux de Paris, Paris, France; Université Pierre et Marie Curie Paris-6 (BB, FF, ML, CA, MG, QL, JJR), Paris, France; and Department of Emergency Medicine (ZH, MZ), Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China.

Fabio Ferarri is a research fellow with the Department of Anesthesiology, Faculdade de Medicina da Universidade Estadual Paulista Julio de Mesquita Filho, Botucatu, Brazil, and recipient of a postdoctorate award from CNPQ-Brasil/Processo 201023/2005-9. Martin Girard is a Research Fellow with the Department of Anesthesiology and Critical Care, Centre Hospitalier de l'Université de Montréal, Canada, and recipient of a scholarship from the Royal College of Physicians and Surgeons of Canada.

Presented, in part, at the 19th Annual Congress of the European Society of Intensive Care Medicine, Barcelona, Spain, September 24–27, 2006.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: jean-jacques.rouby@psl.aphp.fr

© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins