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Caring for the Critically Ill Patient
November 8, 2000

Association of Noninvasive Ventilation With Nosocomial Infections and Survival in Critically Ill Patients

Author Affiliations

Author Affiliations: Unité d'Hygiène et Prévention de l'Infection (Drs Girou and Brun-Buisson), Service de Réanimation Médicale (Drs Schortgen, Delclaux, Brun-Buisson, Blot, Lefort, Lemaire, and Brochard), Institut National de la Santé et de la Recherche Médicale U492 (Drs Delclaux, Lemaire, and Brochard), Hôpital Henri Mondor, Assistance Publique-Hopitaux de Paris, Créteil, France.


Caring for the Critically Ill Patient Section Editor: Deborah J. Cook, MD, Consulting Editor, JAMA.

JAMA. 2000;284(18):2361-2367. doi:10.1001/jama.284.18.2361

Context Invasive life-support techniques are a major risk factor for nosocomial infection. Noninvasive ventilation (NIV) can be used to avoid endotracheal intubation and may reduce morbidity among patients in intensive care units (ICUs).

Objective To determine whether the use of NIV is associated with decreased risk of nosocomial infections and improved survival in everyday clinical practice among patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) or hypercapnic cardiogenic pulmonary edema (CPE).

Design and Setting Matched case-control study conducted in the medical ICU of a French university hospital from January 1996 through March 1998.

Patients Fifty patients with acute exacerbation of COPD or severe CPE who were treated with NIV for at least 2 hours and 50 patients treated with mechanical ventilation between 1993 and 1998 (controls), matched on diagnosis, Simplified Acute Physiology Score II, Logistic Organ Dysfunction score, age, and no contraindication to NIV.

Main Outcome Measures Rates of nosocomial infections, antibiotic use, lengths of ventilatory support and of ICU stay, ICU mortality, compared between cases and controls.

Results Rates of nosocomial infections and of nosocomial pneumonia were significantly lower in patients who received NIV than those treated with mechanical ventilation (18% vs 60% and 8% vs 22%; P<.001 and P = .04, respectively). Similarly, the daily risk of acquiring an infection (19 vs 39 episodes per 1000 patient-days; P = .05), proportion of patients receiving antibiotics for nosocomial infection (8% vs 26%; P = .01), mean (SD) duration of ventilation (6 [6] vs 10 [12] days; P = .01), mean (SD) length of ICU stay (9 [7] vs 15 [14] days; P = .02), and crude mortality (4% vs 26%; P = .002) were all lower among patients who received NIV than those treated with mechanical ventilation.

Conclusions Use of NIV instead of mechanical ventilation is associated with a lower risk of nosocomial infections, less antibiotic use, shorter length of ICU stay, and lower mortality.