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
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
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
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.