Diagnosis of VAP

Bacteria often colonise the airways of patients who are intubated. Therefore, the presence of bacteria in tracheal aspirates is not sufficient for diagnosis of ventilator-associated pneumonia (VAP). Furthermore, most intubated patients with shadowing on chest X-ray do not have pneumonia. Atelectasis is common and usually noninfective; management with physiotherapy is recommended.

Note: Isolation of bacteria from a respiratory tract sample is not sufficient to diagnose VAP.

A diagnosis of VAP is suggested in patients who have a new, progressive, or persistent infiltrate on chest X-ray (not explained by other causes), plus 2 or more of the following featuresAmerican Thoracic, 2005Kalil, 2016Weiss, 2017:

  • fever above 38°C
  • total white cell count above or below the normal range
  • presence, or increased amount, of purulent sputum or lower respiratory tract secretions
  • worsening gas exchange (eg desaturation, increased oxygen requirement, increased ventilator demand).

Although VAP can develop in any mechanically ventilated patient, there is an increasing understanding of the higher rates of bacterial and fungal VAP and tracheobronchitis in patients with Coronavirus disease 2019 (COVID-19)Rouze, 2022Sogaard, 2021. Therefore, consider secondary bacterial or fungal VAP in patients with COVID-19 who are not improving with directed antiviral therapy.