Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients

Context Invasive life-support techniques are a major risk factor for nosoco mial infection. Noninvasive ventilation (NIV) can be used to avoid endotrac heal intubation and may reduce morbidity among patients in intensive care u nits (ICUs). Objective To determine whether the use of NIV is associated with decreased risk of nosocomial infections and improved survival in everyday clinical pr actice among patients with acute exacerbation of chronic obstructive pulmon ary 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 w ere treated with NIV for at least 2 hours and 50 patients treated with mech anical 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, lengt hs of ventilatory support and of ICU stay, ICU mortality, compared between cases and controls, Results Rates of nosocomial infections and of nosocomial pneumonia were sig nificantly lower in patients who received NIV than those treated with mecha nical 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 p er 1000 patient-days; P=.05), proportion of patients receiving antibiotics for nosocomial infection (8% vs 26%, P=.01), mean (SD) duration of ventilat ion (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 lowe r among patients who received NIV than those treated with mechanical ventil ation, 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.