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Mortality rates for hospitalized patients during the first wave of the pandemic were &gt; 30%, but as we enter the fifth year of the pandemic hospitalizations have fallen and mortality rates for hospitalized patients with COVID-19 have plummeted to 5% or less. These gains reflect lessons learned about how to optimize respiratory support for different kinds of patients, targeted use of therapeutics for patients with different manifestations of COVID-19 including immunosuppressants and antivirals as appropriate, and high levels of population immunity acquired through vaccines and natural infections. At the same time, the pandemic has helped highlight some longstanding sources of harm for hospitalized patients including hospital-acquired pneumonia, ventilator-associated events (VAEs), and hospital-acquired respiratory viral infections. We are, thankfully, on the leeside of the pandemic at present; but the large increases in ventilator-associated pneumonia (VAP), VAEs, bacterial superinfections, and nosocomial respiratory viral infections associated with the pandemic beg the question of how best to prevent these complications moving forward. This paper reviews the burden of hospitalization for COVID-19, the intersection between COVID-19 and both VAP and VAEs, the frequency and impact of hospital-acquired respiratory viral infections, new recommendations on how best to prevent VAP and VAEs, and current insights into effective strategies to prevent nosocomial spread of respiratory viruses.<\/jats:p>","DOI":"10.4187\/respcare.11961","type":"journal-article","created":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T14:45:37Z","timestamp":1719585937000},"page":"854-868","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nosocomial Respiratory Viral Infections on the Leeside of the Pandemic"],"prefix":"10.1177","volume":"69","author":[{"given":"Michael","family":"Klompas","sequence":"first","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; and Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,6,28]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6924e2"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-022-04155-1"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.7326\/M21-1213"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.3539"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-021-01633-6"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2022-071966"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.09191"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.7326\/L21-0424"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.2934"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-06294-x"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-021-00812-w"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000005297"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-021-03460-5"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-32265-5"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(23)00408-3"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202202-0357OC"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-06036-z"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0000000000000908"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202106-1354OC"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2021.362"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2022.116"},{"issue":"2","key":"e_1_3_2_23_2","first-page":"230","article-title":"Increased ventilator utilization, ventilator-associated pneumonia, and mortality in non-COVID patients during the pandemic","volume":"37","author":"Okpujie VO","year":"2024","unstructured":"Okpujie VO, , Uwumiro FE, , Bojerenu M, , Alemenzohu H, , Obi ES, , Chigbu NC, et al. 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