Facial mask noninvasive mechanical ventilation reduces the incidence of nosocomial pneumonia. A prospective epidemiological survey from a single ICU

Intensive Care Med. 1997 Oct;23(10):1024-32. doi: 10.1007/s001340050452.


Objective: To evaluate the impact of noninvasive positive pressure mechanical ventilation (NPPV) on ventilator-associated pneumonia (VAP).

Design: Prospective observational study.

Setting: Medical intensive care unit (ICU) of a university teaching hospital.

Patients: Cohort of 320 consecutive patients staying in the ICU more than 2 days and mechanically ventilated for > or = 1 day.

Measurements and 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.

MeSH terms

  • Adult
  • Aged
  • Cross Infection / epidemiology
  • Cross Infection / etiology
  • Cross Infection / prevention & control*
  • Equipment Contamination
  • Female
  • Humans
  • Incidence
  • Intensive Care Units
  • Length of Stay
  • Logistic Models
  • Male
  • Masks*
  • Middle Aged
  • Pneumonia / epidemiology
  • Pneumonia / etiology
  • Pneumonia / prevention & control*
  • Positive-Pressure Respiration / adverse effects
  • Positive-Pressure Respiration / methods*
  • Prospective Studies