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Research ArticleConference Proceedings

Noninvasive Positive-Pressure Ventilation and Ventilator-Associated Pneumonia

Dean R Hess
Respiratory Care July 2005, 50 (7) 924-931;
Dean R Hess
Department of Respiratory Care, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
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Abstract

There is much interest in the use of noninvasive positive-pressure ventilation (NPPV) to prevent intubation and afford a survival benefit for patients. The risk of pneumonia in patients receiving NPPV has been reported in 12 studies. Compared to patients receiving invasive mechanical ventilation (4 studies), the pneumonia rate is lower with the use of NPPV (relative risk [RR] 0.15, 95% confidence interval [CI] 0.04 to 0.58, p = 0.006). Compared to patients assigned to invasive mechanical ventilation (3 studies), in which some of the patients assigned to NPPV did not respond and were eventually intubated, there was also a benefit for the use of NPPV (RR 0.24, 95% CI 0.08 to 0.73, p = 0.01). In studies in which patients assigned to NPPV were compared to patients assigned to standard therapy (5 studies), in which some of the patients in each group were eventually intubated, there was benefit shown for the use of NPPV (RR 0.56, 95% CI 0.31 to 1.02, p = 0.06). When this meta-analysis is repeated without the results of the negative study for NPPV (extubation failure), there is a stronger benefit in support of NPPV to decrease the risk of pneumonia in the remaining 4 studies (RR 0.38, 95% CI 0.20 to 0.73, p = 0.003). A meta-analysis combining the results from the 12 studies reviewed shows a strong benefit for NPPV (RR 0.31, 95% CI 0.16 to 0.57, p = 0.0002). One randomized controlled trial of continuous positive airway pressure compared with standard treatment in patients who developed acute hypoxemia after elective major abdominal surgery reported a lower rate of pneumonia with continuous positive airway pressure (2% vs 10%, RR 0.19, 95% CI 0.04 to 0.88, p = 0.02). In patients who are appropriate candidates for NPPV or continuous positive airway pressure, the available evidence suggests a benefit in terms of a lower risk of pneumonia. Perhaps “endotracheal-tube-associated pneumonia” is a better term than “ventilator-associated pneumonia.”

  • continuous positive airway pressure
  • mechanical ventilation
  • noninvasive positive-pressure ventilation
  • ventilator-associated pneumonia

Footnotes

  • Correspondence: Dean R Hess PhD RRT FAARC, Respiratory Care, Ellison 401, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02114. E-mail: dhess{at}partners.org.
  • Dean R Hess PhD RRT FAARC presented a version of this article at the 35th Respiratory Care Journal Conference, Ventilator-Associated Pneumonia, held February 25–27, 2005, in Cancún, Mexico.

  • Copyright © 2005 by Daedalus Enterprises Inc.
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Respiratory Care: 50 (7)
Respiratory Care
Vol. 50, Issue 7
1 Jul 2005
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Noninvasive Positive-Pressure Ventilation and Ventilator-Associated Pneumonia
Dean R Hess
Respiratory Care Jul 2005, 50 (7) 924-931;

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Noninvasive Positive-Pressure Ventilation and Ventilator-Associated Pneumonia
Dean R Hess
Respiratory Care Jul 2005, 50 (7) 924-931;
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Keywords

  • continuous positive airway pressure
  • mechanical ventilation
  • noninvasive positive-pressure ventilation
  • ventilator-associated pneumonia

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