***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Lung auscultation and bedside chest radiography are routinely used to assess the respiratory condition of ventilated patients with acute respiratory distress syndrome ( ARDS ) . Clinical experience suggests that the diagnostic accuracy of these procedures is poor . Methods This prospect i ve study of 32 patients with ARDS and 10 healthy volunteers was performed to compare the diagnostic accuracy of auscultation , bedside chest radiography , and lung ultrasonography with that of thoracic computed tomography . Three pathologic entities were evaluated in 384 lung regions ( 12 per patient ) : pleural effusion , alveolar consolidation , and alveolar-interstitial syndrome . Results Auscultation had a diagnostic accuracy of 61 % for pleural effusion , 36 % for alveolar consolidation , and 55 % for alveolar-interstitial syndrome . Bedside chest radiography had a diagnostic accuracy of 47 % for pleural effusion , 75 % for alveolar consolidation , and 72 % for alveolar-interstitial syndrome . Lung ultrasonography had a diagnostic accuracy of 93 % for pleural effusion , 97 % for alveolar consolidation , and 95 % for alveolar-interstitial syndrome . Lung ultrasonography , in contrast to auscultation and chest radiography , could quantify the extent of lung injury . Interobserver agreement for the ultrasound findings as assessed by the & kgr ; statistic was satisfactory : 0.74 , 0.77 , and 0.73 for detection of alveolar-interstitial syndrome , alveolar consolidation , and pleural effusion , respectively . Conclusions At the bedside , lung ultrasonography is highly sensitive , specific , and reproducible for diagnosing the main lung pathologic entities in patients with ARDS and can be considered an attractive alternative to bedside chest radiography and thoracic computed tomography Inappropriate therapy ( IT ) and delayed initiation of appropriate therapy ( DIAT ) result in inadequate therapy in patients with ventilator-associated pneumonia ( VAP ) . The aim of the current study was to assess the impact of DIAT in VAP . A total of 76 mechanically ventilated patients with bacteriologically confirmed VAP were prospect ively evaluated in the intensive care unit of six hospitals in Buenos Aires , Argentina .  Appropriate therapy was defined as coverage of all the identified pathogens by the antimicrobial therapy administered at the time of VAP clinical diagnosis . The clinical pulmonary infection score was measured during the 3 days before , at the onset and during the days which followed the onset of VAP . A total of 24 patients received adequate therapy ; mortality was 29.2 % . The remaining 52 patients received either IT ( n = 16 ) or DIAT ( n = 36 ) ; the mortality was 63.5 % combined , and 75.0 and 58.3 % for IT and DIAT , respectively ( statistically significant compared with adequate therapy ) . Inappropriate therapy and delayed initiation of appropriate therapy increased the mortality of ventilator-associated pneumonia . Patients with inappropriate therapy and /or delayed initiation of appropriate therapy had a more gradual increase in clinical pulmonary infection score than those receiving adequate therapy , and this increase was found to occur prior to the time of the clinical diagnosis . In conclusion , these findings might provide the rationale for a trial of earlier initiation of therapy , based on clinical grounds in an effort to improve the outcome of patients with ventilator-associated pneumonia Purpose To compare the diagnostic performance of lung ultrasound and bedside chest radiography ( CXR ) for the detection of various pathologic abnormalities in unselected critically ill patients , using thoracic computed tomography ( CT ) as a gold st and ard . Methods Forty-two mechanically ventilated patients scheduled for CT  were prospect ively studied with a modified lung ultrasound protocol . Four pathologic entities were evaluated : consolidation , interstitial syndrome , pneumothorax , and pleural effusion . Each hemithorax was evaluated for the presence or absence of each abnormality . Results Eighty-four hemithoraces were evaluated by the three imaging techniques . The sensitivity , specificity , and diagnostic accuracy of CXR  were 38 , 89 , and 49 % for consolidation , 46 , 80 , and 58 % for interstitial syndrome , 0 , 99 , and 89 % for pneumothorax , and 65 , 81 , and 69 % for pleural effusion , respectively . The corresponding values for  lung ultrasound  were 100 , 78 , and 95 % for consolidation , 94 , 93 , and 94 % for interstitial syndrome , 75 , 93 , and 92 % for pneumothorax , and 100 , 100 , and 100 % for pleural effusion , respectively . The relatively low sensitivity of lung ultrasound  for pneumothorax could be due to small number of cases ( n = 8) and /or suboptimal methodology . Conclusions In our unselected general ICU population  lung ultrasound has a considerably better diagnostic performance than CXR for the diagnosis of common pathologic conditions and may be used as an alternative to thoracic CT PURPOSE The aim of the study was to assess the utility of pretest probability and modified clinical pulmonary infection score CPIS in the diagnosis of  late-onset ventilator-associated pneumonia ( VAP ) .  MATERIAL S AND METHODS In 740 adults enrolled in a multicenter r and omized trial , intensivists prospect ively rated the pretest probability of VAP as low , moderate , or high based on their clinical judgment . The modified CPIS was calculated without considering culture results . Ventilator-associated pneumonia diagnosis was determined by 2 adjudicators using st and ardized definitions . We analyzed the relationship between pretest likelihood , CPIS , and VAP diagnosis . RESULTS Among the 739 patients analyzed , 14.5 % , 39.6 % , and 45.9 % had low , moderate , and high pretest probability of VAP . Patients with high pretest probability had a lower PaO2/FiO2 ratio and a larger volume of secretions . High or moderate vs low pretest probability had high sensitivity ( 0.88 ; 95 % confidence interval [ CI ] , 0.87 - 0.89 ) and positive predictive value ( 0.87 ; 95 % CI , 0.86 - 0.88 ) but low specificity ( 0.27 ; 95 % CI , 0.21 - 0.35 ) and negative predictive value ( 0.29 ; 95 % C , : 0.22 - 0.37 ) for the diagnosis of VAP . Therefore , 71 % of patients who had a low pretest probability were actually infected ( 1 - negative predictive value ) . The area under the receiver operating characteristic curve for the modified CPIS was not significant ( 0.47 ; 95 % CI , 0.42 - 0.53 ) , meaning that no score threshold was clinical ly useful . CONCLUSIONS Pretest probability and a modified CPIS , which excludes culture results , are of limited utility in the diagnosis of late-onset VAP BACKGROUND The objective of this study was to identify the relationship between a dynamic lung artifact , the dynamic air bronchogram , within alveolar consolidation and the diagnosis of pneumonia vs resorptive atelectasis . METHODS This prospect i ve study was undertaken within the medical ICU of a university-affiliated teaching hospital . The sample comprised 52 patients with proven pneumonia ( pneumonia group ) and 16 patients with proven resorptive atelectasis ( atelectasis group ) . All patients had alveolar consolidation with air bronchograms on lung ultrasound , were mechanically ventilated , and received fibroscopy and bacteriological tests .  The air bronchogram dynamic was analyzed within the ultrasound area of consolidation . RESULTS The air bronchograms in the pneumonia group yielded the dynamic air bronchogram in 32 patients and a static air bronchogram in 20 . In the atelectasis group , air bronchograms yielded a dynamic air bronchogram in 1 out of 16 patients . With regard to pneumonia vs resorptive atelectasis in patients with ultrasound-visible alveolar consolidation with air bronchograms , the dynamic air bronchogram had a specificity of 94 % and a positive predictive value of 97 % . The sensitivity was 61 % , and the negative predictive value 43 % . CONCLUSIONS In patients with alveolar consolidation displaying air bronchograms on an ultrasound , the dynamic air bronchogram indicated pneumonia , distinguishing it from resorptive atelectasis . Static air bronchograms were seen in most resorptive atelectases and one third of cases of pneumonia . This finding increases the underst and ing of the pathophysiology of lung diseases within the clinical context and decreases the need for fibroscopy in practice BACKGROUND To facilitate the clinical diagnosis of  ventilator-associated pneumonia ( VAP ) in the ICU , the Clinical Pulmonary Infection Score ( CPIS ) has been proposed but has shown a low diagnostic performance in subsequent studies . We propose a new score based on procalcitonin level and chest echography with the aim of improving VAP diagnosis : the Chest Echography and Procalcitonin Pulmonary Infection Score ( CEPPIS ) . METHODS This retrospective pilot study recruited patients admitted to the Intensive Care Unit of the Emergency Department , Careggi University Hospital ( Florence , Italy ) , from January 2009 to December 2011 . Patients were retrospectively divided into a microbiologically confirmed VAP group or a control group based on diagnosis of VAP and positive tracheal aspirate culture . RESULTS A total of 221 patients were included , with 113 in the microbiologically confirmed VAP group and 108 in the control group . A  CEPPIS > 5 retrospectively fixed was significantly better in predicting VAP ( OR , 23.78 ; sensitivity , 80.5 % ; specificity , 85.2 % ) than a  CPIS  > 6 ( OR , 3.309 ; sensitivity , 39.8 % ; specificity , 83.3 % ) . The receiver operating characteristic area under the curve analysis also showed a significantly higher diagnostic value for  CEPPIS > 5 than CPIS > 6 ( 0.829 vs 0.616 , respectively ; P < .0001 ) . CONCLUSIONS In this pilot , exploratory analysis , CEPPIS is effective in predicting VAP . Prospect i ve validation is needed to confirm the potential value of this score to facilitate VAP diagnosis BACKGROUND The aim of this prospect i ve , multicenter study was to define the accuracy of lung ultrasound ( LUS ) in the diagnosis of community-acquired pneumonia ( CAP ) . METHODS Three hundred sixty-two patients with suspected CAP were enrolled in 14 European centers . At baseline , history , clinical examination , laboratory testing , and LUS were performed as well as the reference test , which was a radiograph in two planes or a low-dose CT scan in case of inconclusive or negative radiographic but positive LUS findings . In patients with CAP , follow-up between days 5 and 8 and 13 and 16 was scheduled . RESULTS CAP was confirmed in 229 patients ( 63.3 % ) .  LUS revealed a sensitivity of 93.4 % ( 95 % CI , 89.2%-96.3 % ) , specificity of 97.7 % ( 95 % CI , 93.4%-99.6 % ) , and likelihood ratios ( LRs ) of 40.5 ( 95 % CI , 13.2 - 123.9 ) for positive and 0.07 ( 95 % CI , 0.04 - 0.11 ) for negative results . A combination of auscultation and LUS increased the positive LR to 42.9 ( 95 % CI , 10.8 - 170.0 ) and decreased the negative LR to 0.04 ( 95 % CI , 0.02 - 0.09 ) . We found 97.6 % ( 205 of 211 ) of patients with CAP showed breath-dependent motion of infiltrates , 86.7 % ( 183 of 211 ) an air bronchogram , 76.5 % ( 156 of 204 ) blurred margins , and 54.4 % ( 105 of 193 ) a basal pleural effusion . During follow-up , median C-reactive protein levels decreased from 137 mg/dL to 6.3 mg/dL at days 13 to 16 as did signs of CAP ; median area of lesions decreased from 15.3 cm2 to 0.2 cm2 and pleural effusion from 50 mL to 0 mL. CONCLUSIONS LUS is a noninvasive , usually available tool used for high-accuracy diagnosis of CAP . This is especially important if radiography is not available or applicable . About 8 % of pneumonic lesions are not detectable by LUS ; therefore , an inconspicuous LUS does not exclude pneumonia BACKGROUND Presenting signs and symptoms of pulmonary embolism ( PE ) are nonspecific , favoring a large use of second-line diagnostic tests such as multidetector CT pulmonary angiography ( MCTPA ) , thus exposing patients to high-dose radiation and to potential serious complications . We investigated the diagnostic 
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In patients suspected for VAP , lobar or hemilobar consolidation alone was not sufficient to diagnose VAP but seems useful to exclude it .
Conclusion : Small subpleural consolidations and dynamic air bronchograms were the most useful sonographic signs to diagnose VAP in suspected patients .
Clinical scores including LUS had better diagnosis accuracy  than LUS alone .
There are no data on LUS for VAP screening