[Prevention of infections transmitted by CPAP and noninvasive ventilation]

Nosocomial infections are recognized as a major problem in patients with endotracheal ventilation, but the risk of nosocomial pneumonia is less well known and considered to be lower for patients on noninvasive ventilation. The risk factors for endotrachial ventilation involve the presence of the endoracheal canula and the direct consequences of the reclining position, use of a respirator, sedation, presence of a nosgastric tube, antiulcer treatment, etc. Most of these risk factors are not present in noninvasive ventilation while others, for example the use of a respirator and a ventilation circuit, persist. Several recent studies have demonstrated lower rates of infection in noninvasive compared with endotracheal ventilation. The notion of a specific risk of noninvasive ventilation-related nosocomial infection is less certain although current data do show a risk level no higher than in non-ventilated patients. Noninvasive ventilation should therefore be considered as a preventive measure against nosocomial infection whenever it can replace invasive ventilation. More or less specific preventive measures should however be employed. The principal actions involve taking advantage of the noninvasive nature of the ventilation to reduce the risk factors and other invasive procedures indirectly related with the use of artificial ventilation. Patients should be mobilized as rapidly as possible and oral food intake instituted early. Certain measures concerning humidification of the ventilation circuit remain important as well as other nonspecific measures including hand washing, for the prevention of cross contamination.