title: Facial mask noninvasive mechanical ventilation reduces the incidence of nosocomial pneumonia. A prospective epidemiological survey from a single ICU.
abstract: OBJECTIVE
  To evaluate the impact of noninvasive positive pressure mechanical ventilation (NPPV) on ventilator-associated pneumonia (VAP).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Medical intensive care unit (ICU) of a university teaching hospital.
  
  
  METHODS
  Cohort of 320 consecutive patients staying in the ICU more than 2 days and mechanically ventilated for > or = 1 day.
  
  
  RESULTS
  VAP was diagnosed when, satisfying classical clinical and radiological criteria, fiberoptic bronchoalveolar lavage and/or protected specimen brush grew > or = 10(4) and > or = 10(3) CFU/ml, respectively, of at least one microorganism. Patients were classified into four subgroups according to the way in which mechanical ventilation was delivered: NPPV then tracheal intubation (TI) (n = 38), TI then NPPV (n = 23), TI only (n = 199), and NPPV only (n = 60). Occurrence of VAP was estimated by incidence rate and density of incidence. Risk factors for VAP were assessed by logistic regression analysis. Twenty-seven patients had 28 episodes of VAP. The incidence rates for patients with VAP were 18% in NPPV-TI, 22% in TI-NPPV, 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 ventilatory support were associated with VAP.
  
  
  CONCLUSIONS
  There is a significantly lower incidence of VAP associated with NPPV compared to tracheal intubation. This is mainly explained by differences in patient severity and risk exposure.
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.
authors.forename: C
authors.initials: C
authors.lastname: Guérin
authors.forename: R
authors.initials: R
authors.lastname: Girard
authors.forename: C
authors.initials: C
authors.lastname: Chemorin
authors.forename: R
authors.initials: R
authors.lastname: De Varax
authors.forename: G
authors.initials: G
authors.lastname: Fournier
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008397:Masks; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies