Definitions

• Hospital-acquired pneumonia is pneumonia that is not present

or incubating at the time of hospital admission, occurring 48
hours or more after the time of admission;

• ventilator-associated pneumonia is a subset of hospital-acquired

pneumonia, defined as pneumonia occurring in a mechanically
ventilated patient 48 hours or more after endotracheal
intubation

• Most often caused by bacteria, but may also result from

infection with a seasonal virus or, less often, fungus
Classification
• By cause 
• Bacterial
• Most common type
• Viral
• Less frequent, usually seasonal (eg, influenza)
• Fungal
• Rare and usually limited to immunocompromised persons
• By mechanism 
• Ventilator-associated
• Endotracheal tube facilitates introduction of organisms into the lower respiratory tract
• Aspiration
• Often seen with diminished gag reflex, impaired cough, or uncoordinated swallowing;
sedation and underlying esophageal or central nervous system disease are common causes
• May occur during intubation process
Common symptoms

• New onset of fever, usually with temperature greater than 38°C 

• Cough productive of purulent secretions
• New onset of dyspnea or exacerbation of chronic dyspnea
• Fatigue (may be overwhelming)
• Nausea, vomiting, and diarrhea
• Older adults and immunocompromised patients may have fewer or milder
symptoms
• Mental status changes are often the first sign of pneumonia in elderly
patients
Risk Factors
Host related
Age
Lung disease/ARDS
Immunosuppression
Unconsciousness
Body position
Antibiotic exposure
Chest surgery
Re-
intubation/prolonged
intubation

Device related
ETT
Ventilator circuit
Orogastric and
nasogastric tube
 Department of Critical Care Medicine, Apollo Hospitals 
Bundle of VAP Checklist
Covid – 19 Definitions

• COVID-19 is a disease caused by a new strain of coronavirus.

'CO' stands for corona, 'VI' for virus, and 'D' for disease.
Formerly, this disease was referred to as '2019 novel
coronavirus' or '2019-nCoV.

• Corona Virus Disease 2019 due Severe Acut Respiratory Syndrome

Coronavirus 2 infection(SARS-COV-2)
• Covid - 19
Clinical Features

Clinical Features patients with COVID – 19

• 80 % Mild Cases
• 15 % Severe : Hypoxemia SpO2 < 93%
• 5 % Critical : Hypoxemia with Mechanical
Ventilation (NIV/IMV)
(ESICM, Guidelines Covid – 19, 2020)
Summary
• Ventilator-Associated Bacterial Pneumonia (VAP) in COVID-19
inpatients. The co-infection has the potential to worsen clinical
condition and increase mortality in these patients, as well as to prolong
and increase the costs of hospitalization. Preventing, identifying and
treating early VAP can increase the chances of successful treatment in
patients with COVID-19.

• Coronavirus, Covid-19, Co-infection, Microorganisms, Sars-CoV-2,

Secondary infection, Ventilator-associated pneumonia
Cont….

• The endotracheal tube is an interface between the ventilator and the

patient under mechanical ventilation. Potentially pathogenic
microorganisms found in oropharyngeal secretion reach the lower
respiratory tract through the space between the cuff of the
endotracheal tube and the tracheal wall

• This tube also interferes with mucociliary clearance, allowing the

formation of biofilms on the inner and outer surfaces of the tracheal
cannula, increasing the risk of Ventilator-Associated Pneumonia (VAP).
Cont…
• Mechanical ventilation is a common supportive treatment in COVID-
19 patients with acute respiratory distress syndrome, although this
treatment is a predisposing factor for VAP.

• Prevention, early identification and treatment of VAP can influence

treatment success, and, even though, to the best of our knowledge,
there are currently no studies about this aspect regarding COVID-19
patients, this could also be extrapolated to these patients