Transthoracic Ultrasound in the Diagnosis and Follow-up of Ventilator Associated Pneumonia

Study Overview
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Brief Summary
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To evaluate the sensitivity, specificity and diagnostic accuracy of bedside transthoracic ultrasound examination in the diagnosis and follow up of ventilator associated pneumonia.

Detailed Description
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VAP is the most frequent hospital-acquired infection in intensive care units. Depending on the diagnostic criteria used, its incidence ranges from 5% to 67%. The risk of acquiring VAP is 3% per day during the first 5 days on mechanical ventilation, and it is decreased to 1% per day for the following days. VAP is suspected when subject shows high grade fever, increase in leukocyte count, change in color of sputum and tachypnea. It's a leading cause of mortality in 15- 65% of the cases. Serial chest x-ray for diagnosis and follow up, done at time of diagnosis, after 5 days and after 10 days. Chest radiography is consistently carried out after LUS , LUS is done every other day, measuring the largest area of consolidation according to the intercostal space and direction of the probe . Chest radiography is read by two physicians.

Official Title
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Transthoracic Ultrasound in the Diagnosis and Follow-up of Ventilator Associated Pneumonia

Conditions
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Lung Ultrasound, Ventilator Associated Pneumonia

Intervention / Treatment
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* Device: transthoracic ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Mechanical ventilation for at least 48 hours. New or evolving infiltrate on chest radiograph (CXR). Clinical pulmonary infection score more than or equal 6 Exclusion Criteria: Patients who are less than 18 years old. Patients who have evidence of pneumonia before or prior to being mechanically ventilated. Patients with pulmonary infarction.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: lung ultrasound<br>using lung ultrasound in diagnosis and follow up of vap measuring the largest area of consolidation according to intercostal space and the direction of the probe | Device: transthoracic ultrasound<br>* using transthoracic ultrasound in the diagnosis and follow up of vap,measuring the largest area of consolidation according to intercostal space and the direction of the probe.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| detecting ultrasound efficiency in diagnosis and follow up of vap | Sensitivity, specificity, and diagnostic accuracy of lung ultrasound to diagnose and follow up ventilator-associated pneumonia. | baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| icu stay | Duration of stay in ICU. | baseline | 
| hospital stay | Duration of hospital stay. | basline | 
| mortality | mortality from vap | basline |