الفهرس 
PNEUMONIAOnly 14 pages are availabe for public view
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Abstract
Introduction: Lung aeration monitoring in ventilator associated pneumonia (VAP) obtained by ultrasound (LUS) despite there is still no evidence if LUS useful in diagnosis of VAP.1
Subjects and methods::This study was conducted prospectively on thirty-one patients with suspected VAP in RICU at Abbasia chest hospital in the period from 1 June 2016 until 1 April 2017. Clinical suspicion of VAP was based on the classical criteria: MV ≤ 48 h., and two or more of the following clinical criteria: temperature < 38.5_C or < 36.5_C, leukocytosis ≥ 10.5×109/L, or leukopenia < 4.5×109/L, purulent tracheal secretions.2-6
LUS (lung ultrasound score) and EA (Endotracheal Aspiration) were performed within 8 h. from VAP suspicion.Ventilator-associated pneumonia lung ultrasound score [VPLUS] was calculated as follows: two areas with subpleural consolidations = 1 point, one area with dynamic arborescent/linear air bronchogram = 2 points, Purulent EA = 1 point, Positive direct gram stain EA examination = 2 points. VAP diagnosis was confirmed by chest x-ray infiltration. EAgram was considered positive if any bacteria could be visualized after gram stain testing on tracheal secretions. 7-9
Results: Subpleural consolidation alone or Dynamic arborescent/linear air bronchogram alone showed Sensitivity 100% , Specificity 0.0 % , Diagnostic accuracy (DA) 83.9% , Positive Predictive value (PPV) 83.9% , Positive likelihood ratio (LR+) 1.00. Both together in same lobe showed Sensitivity 96.2%, Specificity 20.0 %, Diagnostic accuracy (DA) 83.9%, and Positive Predictive value (PPV) 86.2%, Positive likelihood ratio (LR+) 1.2.
Conclusion: US had low diagnostic characteristics in prediction of VAP. CPIS and SOFA had significant high diagnostic performance in predicting VAP. TLC had significant moderate diagnostic performance; while other factors had no significant performance. Gram stain and culture had low diagnostic characteristics in prediction of VAP.