• Emmanuelle Girou, Christian Brun-Buisson, Solenne Taillé, François Lemaire, and Laurent Brochard.
• Unité d'Hygiène et Prévention de l'Infection, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France. emmanuelle.girou@hmn.ap-hop-paris.fr
• JAMA. 2003 Dec 10; 290 (22): 298529912985-91.

ContextRandomized 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.ObjectiveTo 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).DesignRetrospective, observational cohort study using prospectively collected data from January 1, 1994, through December 31, 2001.SettingA 26-bed medical intensive care unit (ICU) of a French university referral hospital.ParticipantsA cohort of 479 consecutive patients ventilated for acute exacerbation of COPD or CPE.Main Outcome MeasuresThe ICU mortality and incidence rates of ICU-acquired infections.ResultsA 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).ConclusionImplementing 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.

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