Nourdine K, Combes P, Carton M J, Beuret P, Cannamela A, Ducreux J C
Service de Réanimation, Centre Hospitalier de Roanne, France.
Intensive Care Med. 1999 Jun;25(6):567-73. doi: 10.1007/s001340050904.
To observe the nosocomial infection (NI) distribution in ventilated patients of a single intensive care unit (ICU) according to the kind of control of the upper airways: noninvasive positive pressure ventilation (NPPV) versus endotracheal intubation (ETI).
ICU of a general hospital.
Prospective clinical and epidemiologic survey.
In the period December 1994-March 1997, 761 patients were included who needed mechanical ventilation for more than 48 h: 129 were ventilated by NPPV (NPPV group), 607 were intubated (ETI group) and 25 required intubation after a period of NPPV (NPPV-ETI group).
The data used were prospectively collected according to the NI epidemiologic surveillance protocol of "C. CLIN Sud Est, Réa Sud Est", France. NI included a ventilator-associated pneumonia (VAP), catheter-related infection, urinary tract infection and bacteremia. Occurrence of NI was estimated by the density of incidence. Covariate-adjusted NI and VAP risk factors were assessed by the Cox model. The incidence density of total NI was lower for NPPV than for ETI (14.2 versus 30.3 per 1000 patient-days, p < 0.01). The Cox model showed that the use of noninvasive ventilation, adjusted to the severity of illness (SAPS II), reduced not only the VAP risk (hazard ratio (HR) = 4.07) but also the NI risk (HR = 1.95).
The use of NPPV reduces the risk of VAP and NI, compared to ETI, irrespective of the severity of the patient's illness.
根据上呼吸道控制方式，即无创正压通气（NPPV）与气管插管（ETI），观察某一重症监护病房（ICU）中接受机械通气患者的医院感染（NI）分布情况。
一家综合医院的ICU。
前瞻性临床与流行病学调查。
在1994年12月至1997年3月期间，纳入761例需要机械通气超过48小时的患者：129例采用NPPV通气（NPPV组），607例接受插管（ETI组），25例在一段时间的NPPV后需要插管（NPPV-ETI组）。
根据法国“C. CLIN Sud Est, Réa Sud Est”的NI流行病学监测方案前瞻性收集数据。NI包括呼吸机相关性肺炎（VAP）、导管相关感染、尿路感染和菌血症。NI的发生通过发病密度进行估计。通过Cox模型评估经协变量调整的NI和VAP危险因素。NPPV组的总NI发病密度低于ETI组（每1000患者日分别为14.2和30.3，p < 0.01）。Cox模型显示，根据疾病严重程度（简化急性生理学评分II（SAPS II））调整后，使用无创通气不仅降低了VAP风险（风险比（HR） = 4.07），还降低了NI风险（HR = 1.95）。
与ETI相比，无论患者疾病严重程度如何，使用NPPV均可降低VAP和NI的风险。
