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Master Thesis

Diagnostic échographique des pneumopathies acquises sous ventilation mécanique en réanimation pédiatrique

Abstract : Background: Ventilator-associated-pneumonia (VAP) is a leading cause of nosocomial infections in paediatric intensive care unit (PICU) with increased morbidity and mortality, length of intubation and hospitalisation. Lung ultrasound (LUS) has been successfully applied to diagnose community-acquired-pneumonia in children and VAP in adult and neonatal population. The objective was to evaluate LUS performances in the diagnosis of VAP in a PICU. Method: Monocentric, prospective study between November 1, 2018 and July 31, 2020 in a 12-beds PICU in Saint Denis, La Réunion were included all patients under 18 years old that were admitted to the PICU, mechanically ventilated for more than 48 hours. LUS was performed daily and compared to diagnostic of VAP by the center of disease control (CDC) 2018 score identified as the “gold-standard”. Measurements and main results: Fifty-seven patients were included. Median age was 8 [2.7-34.1] months. Nineteen (33%) children developed a VAP, among which 9 (47%) had a microbiological confirmation. The incidence of VAP was 18 (95% CI 10.8-28.1) /1000 days of ventilation. For LUS diagnosis, the most accurate sign was the dynamic air bronchogram (DAB) with 94.1 [90.8-96.5] % specificity. Accuracy was improved with the association of LUS and the clinical score: DAB had a positive and negative predictive value of 80 [28.4-99.5] %, and 96 [93.1-97.9] %, respectively, and the B-lines sensitivity and specificity were 100 [79.4-100] % and 95.5 [92.4-97.6] %. The simultaneous presence of clinical criteria of CDC, DAB, sub-pleural consolidations and microbiological confirmation allowed to achieve 66,7 [9.2-99.2] % positive predictive value and 98 [95.7-99.3] % negative predictive value. Conclusion: DAB was the most accurate sonographic sign to diagnose VAP in suspected patients associated with clinical score and microbiology.
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Master Thesis
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Submitted on : Monday, April 12, 2021 - 10:37:58 AM
Last modification on : Tuesday, October 19, 2021 - 5:56:41 PM
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  • HAL Id : dumas-03195810, version 1


Justine Uguen. Diagnostic échographique des pneumopathies acquises sous ventilation mécanique en réanimation pédiatrique. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03195810⟩



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