 |
|
Secular Trends in Nosocomial Infections and Mortality Associated With Noninvasive Ventilation in Patients With Exacerbation of COPD and Pulmonary Edema
Emmanuelle Girou, PharmD;
Christian Brun-Buisson, MD;
Solenne Taillé, Biomed Eng Master;
François Lemaire, MD;
Laurent Brochard, MD
JAMA. 2003;290:2985-2991.
Context Randomized controlled trials have shown that the use of noninvasive ventilation (NIV) reduces the need for endotracheal intubation and invasive mechanical ventilation and reduces complication rates and mortality in selected groups of patients. But whether these benefits translate to a clinical setting is unclear.
Objective To evaluate longitudinally the routine implementation of NIV and its effect on patients admitted to the intensive care unit (ICU) with acute exacerbation of chronic obstructive pulmonary disease (COPD) or severe cardiogenic pulmonary edema (CPE).
Design Retrospective, observational cohort study using prospectively collected data from January 1, 1994, through December 31, 2001.
Setting A 26-bed medical intensive care unit (ICU) of a French university referral hospital.
Participants A cohort of 479 consecutive patients ventilated for acute exacerbation of COPD or CPE.
Main Outcome Measures The ICU mortality and incidence rates of ICU-acquired infections.
Results A significant increase in NIV use and a concomitant decrease in mortality and ICU-acquired infection rates were observed over the study years. With adjustment for relevant covariates and propensity scores, NIV was identified as an independent factor linked with a reduced risk of death in the cohort (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.18-0.78), whereas a high severity score on admission (OR, 1.05; 95% CI, 1.01-1.10) and the occurrence of a nosocomial infection (OR, 3.08; 95% CI, 1.62-5.84) were independently associated with death. Rates of ICU-acquired pneumonia decreased from 20% in 1994 to 8% in 2001 (P = .04).
Conclusion Implementing routine use of NIV in critically ill patients with acute exacerbation of COPD or severe CPE was associated with improved survival and reduction of nosocomial infections.
Author Affiliations: Unité d'Hygiène et Prévention de l'Infection (Drs Girou and Brun-Buisson), Service de Réanimation Médicale (Drs Brun-Buisson, Taillé, Lemaire, and Brochard), INSERM U492 (Drs Lemaire and Brochard), Hôpital Henri Mondor, Assistance Publique–Hôpitaux de Paris, Créteil, France.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema
Gray et al.
NEJM 2008;359:142-151.
ABSTRACT
| FULL TEXT
Definitive Care for the Critically Ill During a Disaster: Medical Resources for Surge Capacity: From a Task Force for Mass Critical Care Summit Meeting, January 26-27, 2007, Chicago, IL
Rubinson et al.
Chest 2008;133:32S-50S.
ABSTRACT
| FULL TEXT
Noninvasive positive pressure ventilation in the acute care setting: where are we?
Ambrosino and Vagheggini
Eur Respir J 2008;31:874-886.
ABSTRACT
| FULL TEXT
Early continuous positive airway pressure in acute cardiogenic pulmonary oedema
Masip
Eur Heart J 2007;28:2823-2824.
FULL TEXT
Noninvasive Ventilation for Critical Care
Garpestad et al.
Chest 2007;132:711-720.
ABSTRACT
| FULL TEXT
Utilization of critical care resources is increasing--are we ready?
Schumaker and Hill
J Intensive Care Med 2006;21:191-193.
Utilization of Noninvasive Ventilation in Acute Care Hospitals: A Regional Survey
Maheshwari et al.
Chest 2006;129:1226-1233.
ABSTRACT
| FULL TEXT
Ventilator-Associated Pneumonia: Insights From Recent Clinical Trials
Shorr and Kollef
Chest 2005;128:583S-591S.
ABSTRACT
| FULL TEXT
|
