COVID-19: An Alert to Ventilator-Associated Bacterial Pneumonia
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COMMENTARY
COVID-19: An Alert to Ventilator-Associated Bacterial Pneumonia Helve´cio Cardoso Correˆa Po´voa . Gabriela Ceccon Chianca . Natalia Lopes Pontes Po´voa Iorio
Received: April 11, 2020 Ó The Author(s) 2020
ABSTRACT Key Summary Points This manuscript aims to highlight the risk of 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.
Keywords: Coronavirus; Covid-19; Coinfection; Microorganisms; Sars-CoV-2; Secondary infection; Ventilator-associated pneumonia
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). The hypothesis of this manuscript is that COVID-19 patients under mechanical ventilation can acquire VAP and so worsen their clinical condition. 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.
Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12340496. H. C. C. Po´voa G. C. Chianca N. L. P. P. Iorio (&) Department of Basic Science, Universidade Federal Fluminense, Nova Friburgo, Rio de Janeiro, Brazil e-mail: [email protected]
Infect Dis Ther
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.
COMMENTARY Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is responsible for the present outbreak of a coronavirus-associated acute respiratory disease called coronavirus disease 19 (COVID-19) [1]. To date (May 15, 2020), the COVID-19 pandemic has spread to 215 countries, areas or territories with 4,587,113 confirmed cases and 306,119 confirmed deaths [2]. The risk of serious disease and death from COVID-19 is higher in the elderly, and the lungs are the main organs involved [3, 4]. SARSCoV-2 can cause immune dysregulation due to increased production and circulation of cytokines, leading to hyper-inflammation and defects in lymphoid function [5, 6]. This virus infects most of the ciliated cells in the alveoli, and these cells stop carrying out their normal activity, which consists of clearing the airways. Consequently, there is progressive accumulat
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