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Uguen J, Bouscaren N, Pastural G, Darrieux E, Lopes AA, Levy Y, Peipoch L. Lung ultrasound: A potential tool in the diagnosis of ventilator-associated pneumonia in pediatric intensive care units. Pediatr Pulmonol 2024; 59:758-765. [PMID: 38131518 DOI: 10.1002/ppul.26827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 11/11/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in pediatric intensive care unit (PICU), increasing mortality, antibiotics use and duration of ventilation and hospitalization. VAP diagnosis is based on clinical and chest X-ray (CXR) signs defined by the 2018 Center for Disease Control (gold standard). However, CXR induces repetitive patients' irradiation and technical limitations. This study aimed to investigate if lung ultrasound (LUS) can substitute CXR in the VAP diagnosis. METHODS A monocentric and prospective study was conducted in a French tertiary care hospital. Patients under 18-year-old admitted to PICU between November 2018 and July 2020 with invasive mechanical ventilation for more than 48 h were included. The studied LUS signs were consolidations, dynamic air bronchogram, subpleural consolidations (SPC), B-lines, and pleural effusion. The diagnostic values of each sign associated with clinical signs (cCDC) were compared to the gold standard approach. LUS, chest X-ray, and clinical score were performed daily. RESULTS Fifty-seven patients were included. The median age was 8 [3-34] months. Nineteen (33%) children developed a VAP. In patients with VAP, B-Lines, and consolidations were highly frequent (100 and 68.8%) and, associated with cCDC, were highly sensitive (100 [79-100] % and 88 [62-98] %, respectively) and specific (95.5 [92-98] % and 98 [95-99] %, respectively). Other studied signs, including SPC, showed high specificity (>97%) but low sensibility (<50%). CONCLUSION LUS seems to be a powerful tool for VAP diagnosis in children with a clinical suspicion, efficiently substituting CXR, and limiting children's exposure to ionizing radiations.
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Affiliation(s)
- Justine Uguen
- Paediatric Intensive Care Unit, University Hospital Center Félix Guyon, La Réunion, France
| | - Nicolas Bouscaren
- Public Health Department, Inserm CIC 1410, University Hospital Center Saint Pierre, La Réunion, France
| | - Gaëlle Pastural
- Paediatric Radiology Department, University Hospital Center Félix Guyon, La Réunion, France
| | - Etienne Darrieux
- Paediatric Intensive Care Unit, University Hospital Center Félix Guyon, La Réunion, France
| | - Anne-Aurélie Lopes
- Paediatric Emergency Department, University Hospital Robert-Debre, Sorbonne University, Paris, France
| | - Yael Levy
- Paediatric Intensive Care Unit, University Hospital Center Félix Guyon, La Réunion, France
| | - Lise Peipoch
- Paediatric Intensive Care Unit, University Hospital Center Félix Guyon, La Réunion, France
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Mercado-Longoria R, Galindo-Galindo JO, Ataxca-Gonzalez MA, Colunga-Pedraza PR, Peña-Lozano SP, Llaca-Díaz JM, Rendón-Ramírez EJ. Thoracic ultrasound alone or in combination with tracheal amylase as a tool predictor of ventilator-associated pneumonia in neurocritical patients. Medicine (Baltimore) 2022; 101:e32149. [PMID: 36482529 PMCID: PMC9726279 DOI: 10.1097/md.0000000000032149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In this study, we aim to evaluate whether thoracic ultrasound (TUS) and tracheal amylase (TA) alone or in combination can predict the development of ventilator-associated pneumonia (VAP) in neurocritical patients. Consecutive adult patients with neurocritical disease with normal chest radiographs who required intensive care unit admission and mechanical ventilation between March 2015 and July 2018 were included. TUS and Amylase levels were measured during the first 24 hours and repeated 48 hours after orotracheal intubation. Forty-three patients with a median age of 34 years (17-82) were included. TUS had a sensitivity of 100% and specificity of 96.3% as a predictor of VAP within the first 48 hours when nonpattern A was observed. TA levels > 200 UI/L in the first 48 hours had a sensitivity of 87.5%, and specificity of 63% as a predictor of VAP. Moreover, no benefit of TUS plus TA compared to TUS alone as a predictor of VAP was found. The identification of abnormal TUS patterns in the first 48 hours of orotracheal intubation is a significant predictor of VAP in neurocritical patients.
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Affiliation(s)
- Roberto Mercado-Longoria
- Pulmonary and Critical Care Medicine Service, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Juan O. Galindo-Galindo
- Pulmonary and Critical Care Medicine Service, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Mario A. Ataxca-Gonzalez
- Pulmonary and Critical Care Medicine Service, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Perla R. Colunga-Pedraza
- Internal Medicine, Department, Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma de Nuevo León, Monterrey, México
| | - Samantha P. Peña-Lozano
- Internal Medicine, Department, Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma de Nuevo León, Monterrey, México
| | - Jorge M. Llaca-Díaz
- Clinical Pathology Department, Hospital Universitario, UANL, Monterrey, Nuevo León, México
| | - Erick J. Rendón-Ramírez
- Pulmonary and Critical Care Medicine Service, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
- * Correspondence: Erick J. Rendón-Ramírez, Pulmonary and Critical Care Medicine Service, Hospital Universitario Dr. José Eleuterio, González, Universidad Autónoma de Nuevo León, Ave. Madero y Ave. Gonzalitos s/n, Colonia Mitras Centro, C.P., Monterrey, N.L. 64460, México (e-mail: )
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Gregorova M, Morse D, Brignoli T, Steventon J, Hamilton F, Albur M, Arnold D, Thomas M, Halliday A, Baum H, Rice C, Avison MB, Davidson AD, Santopaolo M, Oliver E, Goenka A, Finn A, Wooldridge L, Amulic B, Boyton RJ, Altmann DM, Butler DK, McMurray C, Stockton J, Nicholls S, Cooper C, Loman N, Cox MJ, Rivino L, Massey RC. Post-acute COVID-19 associated with evidence of bystander T-cell activation and a recurring antibiotic-resistant bacterial pneumonia. eLife 2020; 9:e63430. [PMID: 33331820 PMCID: PMC7775105 DOI: 10.7554/elife.63430] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/16/2020] [Indexed: 12/24/2022] Open
Abstract
Here, we describe the case of a COVID-19 patient who developed recurring ventilator-associated pneumonia caused by Pseudomonas aeruginosa that acquired increasing levels of antimicrobial resistance (AMR) in response to treatment. Metagenomic analysis revealed the AMR genotype, while immunological analysis revealed massive and escalating levels of T-cell activation. These were both SARS-CoV-2 and P. aeruginosa specific, and bystander activated, which may have contributed to this patient's persistent symptoms and radiological changes.
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Affiliation(s)
- Michaela Gregorova
- School of Cellular and Molecular Medicine, University of BristolBristolUnited Kingdom
| | - Daniel Morse
- School of Cellular and Molecular Medicine, University of BristolBristolUnited Kingdom
| | - Tarcisio Brignoli
- School of Cellular and Molecular Medicine, University of BristolBristolUnited Kingdom
| | - Joseph Steventon
- School of Cellular and Molecular Medicine, University of BristolBristolUnited Kingdom
| | | | | | | | | | - Alice Halliday
- School of Cellular and Molecular Medicine, University of BristolBristolUnited Kingdom
| | - Holly Baum
- School of Cellular and Molecular Medicine, University of BristolBristolUnited Kingdom
| | - Christopher Rice
- School of Cellular and Molecular Medicine, University of BristolBristolUnited Kingdom
| | - Matthew B Avison
- School of Cellular and Molecular Medicine, University of BristolBristolUnited Kingdom
| | - Andrew D Davidson
- School of Cellular and Molecular Medicine, University of BristolBristolUnited Kingdom
| | - Marianna Santopaolo
- School of Cellular and Molecular Medicine, University of BristolBristolUnited Kingdom
| | - Elizabeth Oliver
- School of Cellular and Molecular Medicine, University of BristolBristolUnited Kingdom
| | - Anu Goenka
- School of Cellular and Molecular Medicine, University of BristolBristolUnited Kingdom
| | - Adam Finn
- School of Cellular and Molecular Medicine, University of BristolBristolUnited Kingdom
| | - Linda Wooldridge
- Bristol Veterinary School in the Faculty of Health SciencesBristolUnited Kingdom
| | - Borko Amulic
- School of Cellular and Molecular Medicine, University of BristolBristolUnited Kingdom
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College LondonLondonUnited Kingdom
- Lung Division, Royal Brompton & Harefield NHS Foundation TrustLondonUnited Kingdom
| | - Daniel M Altmann
- Department of Infectious Disease, Imperial College LondonLondonUnited Kingdom
| | - David K Butler
- Department of Infectious Disease, Imperial College LondonLondonUnited Kingdom
| | - Claire McMurray
- Institute of Microbiology and Infection, University of BirminghamBirminghamUnited Kingdom
| | - Joanna Stockton
- Institute of Microbiology and Infection, University of BirminghamBirminghamUnited Kingdom
| | - Sam Nicholls
- Institute of Microbiology and Infection, University of BirminghamBirminghamUnited Kingdom
| | - Charles Cooper
- Institute of Microbiology and Infection, University of BirminghamBirminghamUnited Kingdom
| | - Nicholas Loman
- Institute of Microbiology and Infection, University of BirminghamBirminghamUnited Kingdom
| | - Michael J Cox
- Lung Division, Royal Brompton & Harefield NHS Foundation TrustLondonUnited Kingdom
| | - Laura Rivino
- School of Cellular and Molecular Medicine, University of BristolBristolUnited Kingdom
| | - Ruth C Massey
- School of Cellular and Molecular Medicine, University of BristolBristolUnited Kingdom
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Kanal A, Sharpe BA, Abelson J. Management of Pneumonia Syndromes in the Hospital: Make Pneumonia Your Best Friend. Med Clin North Am 2020; 104:587-599. [PMID: 32505254 DOI: 10.1016/j.mcna.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Abraham Kanal
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco (UCSF), Box 0131, San Francisco, CA 94143, USA
| | - Bradley A Sharpe
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco (UCSF), Box 0131, San Francisco, CA 94143, USA.
| | - Jesse Abelson
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco (UCSF), Box 0131, San Francisco, CA 94143, USA. https://twitter.com/AbelsonJesse
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Abstract
There is a wide variety of causes of diffuse lung disease in the intensive care unit patient, of which adult respiratory distress syndrome is the commonest clinical consideration. Plain radiography, computed tomography, and ultrasound can be used synergistically to evaluate patients with diffuse lung disease and respiratory impairment. Imaging is not limited to characterization of the cause of diffuse lung disease but also aids in monitoring its evolution and in ventilator setting management.
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Affiliation(s)
- Konstantinos Stefanidis
- Radiology Department, King's College Hospital, NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK.
| | - Joanna Moser
- Radiology Department, St. George's University Hospitals, NHS Foundation Trust and School of Medicine, Blackshaw Road Tooting, London SW17 0QT, UK
| | - Ioannis Vlahos
- Radiology Department, St. George's University Hospitals, NHS Foundation Trust and School of Medicine, Blackshaw Road Tooting, London SW17 0QT, UK
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Dsouza R, Spillman DR, Barkalifa R, Monroy GL, Chaney EJ, White KC, Boppart SA. In vivo detection of endotracheal tube biofilms in intubated critical care patients using catheter-based optical coherence tomography. J Biophotonics 2019; 12:e201800307. [PMID: 30604487 PMCID: PMC6470036 DOI: 10.1002/jbio.201800307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/21/2018] [Accepted: 01/02/2019] [Indexed: 06/09/2023]
Abstract
The formation of biofilms in the endotracheal tubes (ETTs) of intubated patients on mechanical ventilation is associated with a greater risk of ventilator-associated pneumonia and death. New technologies are needed to detect and monitor ETTs in vivo for the presence of these biofilms. Longitudinal OCT imaging was performed in mechanically ventilated subjects at 24-hour intervals until extubation to detect the formation and temporal changes of in vivo ETT biofilms. OCT-derived attenuation coefficient images were used to differentiate between mucus and biofilm. Extubated ETTs were examined with optical and electron microscopy, and all imaging results were correlated with standard-of-care clinical test reports. OCT and attenuation coefficient images from four subjects were positive for ETT biofilms and were negative for two subjects. The processed and stained extubated ETTs and clinical reports confirmed the presence/absence of biofilms in all subjects. Our findings confirm that OCT can detect and differentiate between biofilm-positive and biofilm-negative groups (P < 10-5 ). OCT image-based features may serve as biomarkers for direct in vivo detection of ETT biofilms and help drive investigation of new management strategies to reduce the incidence of VAP.
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Affiliation(s)
- Roshan Dsouza
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N Mathews Ave, Urbana, Illinois 61801, USA
| | - Darold R. Spillman
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N Mathews Ave, Urbana, Illinois 61801, USA
| | - Ronit Barkalifa
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N Mathews Ave, Urbana, Illinois 61801, USA
| | - Guillermo L. Monroy
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N Mathews Ave, Urbana, Illinois 61801, USA
- Department of Bioengineering, University of Illinois at Urbana-Champaign, 1270 Digital Computer Laboratory, MC-278, Urbana, Illinois 61801, USA
| | - Eric J. Chaney
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N Mathews Ave, Urbana, Illinois 61801, USA
| | - Karen C. White
- Critical Care Medicine, Carle Foundation Hospital, 611 W. Park Street, Urbana, Illinois 61801, USA
| | - Stephen A. Boppart
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 N Mathews Ave, Urbana, Illinois 61801, USA
- Department of Bioengineering, University of Illinois at Urbana-Champaign, 1270 Digital Computer Laboratory, MC-278, Urbana, Illinois 61801, USA
- Carle-Illinois College of Medicine, University of Illinois at Urbana-Champaign, 807 S. Wright St., Urbana, Illinois 61801, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, 306 N. Wright St., Urbana, Illinois 61801, USA
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Biernawska J, Zukowski M, Zegan-Barańska M, Zukowska A. [Cefepim in empiric therapy of ventilator-associated pneumonia]. Anestezjol Intens Ter 2009; 41:242-245. [PMID: 20201347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The most common infection following surgical treatment, when mechanical ventilation and tracheal intubation are used, is ventilator-associated pneumonia (VAP) induced by Gram-negative and Gram-positive bacteria. Its treatment is difficult due to increasingly high antimicrobial drug resistance observed recently. CASE REPORT A 73-year-old patient was admitted to undergo coronary artery bypass grafting and cardiac aneurysm excision. Additionally, chronic circulatory insufficiency (NYHA 2) with ejection fraction of 30% together with hypertension and type 2 diabetes were diagnosed. After extracorporeal circulation, she was given adrenaline/noradrenaline and intra-aortic balloon pump. Postoperatively, elevated levels of CRP (70 mg L(-1)) and of procalcitonin (22.4 ng mL(-1)) were detected. Empiric therapy with cefepime 1 g x 2 iv was started. X-ray revealed atelectasis in the middle left lung lobe and Enterobacter cloacae was isolated from the bronchial tree. Patient was intubated and mechanically ventilated. Antibiotic therapy with cefepime was continued for 10 days and resulted in improvement of patient's general condition. On postoperative day 7, she was transferred from ITU to the cardiac surgery ward. CONCLUSION Cefepime applied empirically to a VAP patient can effectively treat the lung infection and improve his/her general condition.
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Affiliation(s)
- Jowita Biernawska
- Oddział Anestezjologii, Reanimacji i Intensywnej Terapii z Pododdziałem Ostrych Zatruć SPSK Nr 2 w Szczecinie.
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Baĭgozina EA, Sovalkin VI, Lukach VN. [Analysis of the clinical features and outcome of ventilator-associated Pseudomonas aeruginosa-related pneumonia in an intensive care unit]. Anesteziol Reanimatol 2009:62-64. [PMID: 19514444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The occurrence, the course, and outcome of ventilator-associated pneumonia (VAP) related to Pseudomonas aeruginosa were prospectively followed up in 51 patients treated at an intensive care unit. The characteristic feature of P. aeruginosa-induced VAP was its severe course and poor prognosis (mortality was 38%). More than half of cases were found to have bilateral lung injury with the upper left lung being involved. Lung tissue destruction and edema were rather frequent complications. The predictors of death in VAP caused by P. aeruginosa are admission to an intensive care unit, septic shock, and infection.
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