The challenge of ventilator-associated pneumonia diagnosis in COVID-19 patients

Excerpt

While different phenotypes have been evidenced in ICU COVID-19 pneumonia [1], most patients meet ARDS Berlin definition associating bilateral radiologic infiltrates with severe hypoxemia. COVID-19 patients frequently require prolonged invasive mechanical ventilation (MV) including prone positioning, heavy sedation, and muscle blockers for several weeks. In addition, there is clear evidence of prolonged immunosuppression including deep lymphopenia [2]. This accounts for a high risk of secondary hospital-acquired infections, primarily ventilator-associated pneumonia (VAP). The diagnosis of ventilator-associated infections remains challenging due to major definition heterogeneity of multiple clinical entities, and no consensus has yet been reached on appropriate diagnostic strategies for VAP. Irrespective of the definition, accurate diagnosis of VAP requires clinical signs of infection, microbiological documentation, and chest X-ray findings, even if the latter may be difficult to interpret due to preexisting parenchymal injury [3]. …