FACIAL MASK NONINVASIVE MECHANICAL VENTILATION REDUCES THE INCIDENCE OF NOSOCOMIAL PNEUMONIA - A PROSPECTIVE EPIDEMIOLOGIC SURVEY FROM A SINGLE ICU

Objective: To evaluate the impact of noninvasive positive pressure mec hanical ventilation (NPPV) on ventilator-associated pneumonia (VAP). D esign: Prospective observational study, Setting: Medical intensive car e unit (ICU) of a university teaching hospital. Patients: Cohort of 32 0 consecutive patients staying in the ICU more than 2 days and mechani cally ventilated for greater than or equal to 1 day, Measurements and results: VAP was diagnosed when, satisfying classical clinical and rad iological criteria, fiberoptic bronchoalveolar lavage and/or protected specimen brush grew greater than or equal to 10(4) and greater than o r equal to 10(3) CFU/ml, respectively, of at least one microorganism. Patients were classified into four subgroups according to the way in w hich mechanical ventilation was delivered: NPPV then tracheal intubati on (TI) (n = 38), TI then NPPV (N = 23), TI only (n = 199), and NPPV o nly (n = 60), Occurrence of VAP was estimated by incidence rate and de nsity of incidence, Risk factors for VAP were assessed by logistic reg ression analysis, Twenty-seven patients had 25 episodes of VAP. The in cidence rates for patients with VAP were 18 % In NPPV-TI, 22 % in TI-N PPV, 8 % in TI, and 0 % in NPPV (p < 0.0001), The density of incidence : of VAP was 0.85 per 100 days of TI and 0.16 per 100 days of NPPV (p = 0.04). Logistic regression showed that length of ICU stay and ventil atory support were associated with VAP, Conclusions: There is a signif icantly lower incidence of VAP associated with NPPV compared ro trache al intubation, This is mainly explained by differences in patient seve rity and risk exposure.