Clinical Case: Ventilator Associated Pneumonia

A 62 year old gentleman is 6 days post cardiac bypass surgery. The ICU has had difficulty weaning the patient from the ventilator.

Over the past 24 hours, the patient's ventilator requirements have increased. There have also been an increase in endotracheal secretions.

You perform a bedside ultrasound, which reveals this image:

This is an example of consolidation seen on ultrasound secondary to a ventilator-associated pneumonia. Non-translobar consolidation is confirmed by the "shred sign", which is seen as the irregular line at the bottom of the screen. This irregular line marks the boundary between the consolidated and non-consolidated lung. 

It is important to differentiate atelectasis from pneumonia when consolidation is present on ultrasound. The dynamic air bronchograms, as seen above, are more suggestive of a pneumonia. In the image above, clear, anechoic airways are visualized, and these airways change dynamically during inspiration and expiration.

For more information on signs of consolidation and dynamic air bronchograms, check out Dr. Lichtenstein's videos below.

Signs of consolidation: 

Differentiating atelectasis from pneumonia: