الفهرس 
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Abstract
This study involved a cohort of 50 adult patients who were intubated and mechanically ventilated while receiving care in the intensive care unit (ICU). However, 9 patients were excluded from the study due to extubation or death occurring prior to the clinical suspicion of ventilator-associated pneumonia (VAP). As a result, a total of 41 patients were included in the final analysis.
The objective of our study was to assess and compare the diagnostic efficacy of lung ultrasonography (LUS) and serum surfactant protein-D (SP-D) biomarker in the early diagnosis of ventilator-associated pneumonia (VAP) among patients in the intensive care unit (ICU).
In the present study , we examined a cohort of 41 adult patients who were critically ill, intubated, and receiving mechanical ventilation. Following the clinical suspicion of ventilator-associated pneumonia (VAP), the clinical suspicion was made based on the classical criteria. These criteria included the patient being on mechanical ventilation for at least 48 hours, along with the presence of two or more of the following indicators: fever (≥ 38.5ºC) or hypothermia (<36.5ºC), leukocytosis (>11,000/ml) or leukopenia (<4000/ml), purulent tracheal secretions, and a Pao2/Fio2 ratio of less than 300mmHg.
A lung ultrasound examination and sampling of the SP-D biomarker were conducted for all participants in the study at two specific time points. The first one took place within the initial 24 hours of admission, while the second examination occurred at the time of enrollment when there was a clinical suspicion of ventilator-associated pneumonia (VAP). The diagnosis was confirmed through a positive Sputum culture, which was conducted for all patients upon clinical suspicion. The positive results of the EAquant test established the diagnosis of Ventilator-Associated Pneumonia (VAP) when the concentration of microorganisms exceeded 10^4 Colony Forming Units per millilitre.
Additionally, the study incorporated the following variables:In the intensive care unit (ICU), routine assessments were conducted to measure temperature, blood pressure, heart rate, and oxygen saturation. Additionally, standard investigations such as complete blood count (CBC), electrolyte analysis, arterial blood gas (ABG) analysis, and other relevant tests were performed on a regular basis.
Additionally, the presence of consolidation on chest X-ray was documented and compared between the time of admission and the time of enrolment.
The reported findings in ultrasound for diagnosing pneumonia included areas of subpleural consolidation, sites of lobar and hemilobar consolidation, areas of airbronchogram, and basilar pleural effusion.
Our study revealed that serum surfactant protein-D exhibited greater diagnostic accuracy compared to lung ultrasonography in the identification of patients with ventilator-associated pneumonia. The cut off value for surfactant protein D (SP-D) in the diagnosis of ventilator-associated pneumonia (VAP) was found to be greater than 66, with a sensitivity of 94.1% and specificity of 85.7%. The positive predictive value (PPV) was determined to be 97%, while the negative predictive value (NPV) was 75%. The area under the receiver operating characteristic (ROC) curve was calculated to be 0.931. In comparison, lung ultrasound (LUS) imaging, specifically the presence of consolidation and air bronchogram, exhibited a sensitivity of 88.2%, specificity of 71.4%, PPV of 93.4%, NPV of 55.6%, and a ROC curve of 0.798.
In relation to the sonographic patterns seen in our study, namely sub-pleural consolidation, lobar or hemi-lobar consolidation, air bronchogram, and basilar pleural effusion, the corresponding sensitivity values were found to be 79.4%, 32.5%, 94.1%, and 55.8% respectively. Additionally, the specificity values for these patterns were determined to be 100%, 71.4%, 71.4%, and 57.1% respectively. The ultrasonographic signs of sub-pleural consolidation and air bronchogram have been identified as highly valuable indicators for diagnosing ventilator-associated pneumonia (VAP).
In relation to the utilisation of chest X-ray as a diagnostic tool for ventilator-associated pneumonia (VAP), our study findings indicate that out of the 34 cases that tested positive for culture, 25 instances (73.5%) exhibited positive chest X-ray consolidation. This observed correlation was found to be statistically significant, with a p-value of less than 0.05. The sensitivity and specificity of the chest X-ray in detecting VAP were determined to be 73.5% and 71.4% respectively.
Based on our findings, it has been determined that the serum surfactant protein-D biomarker is more effective in the early diagnosis of ventilator-associated pneumonia compared to lung ultrasonography.