Clinical factors associated with noninvasive ventilation-associated pneumonia in acute respiratory failure: a prospective cohort study.

BACKGROUND

Noninvasive ventilation (NIV) is preferred to invasive mechanical ventilation (IMV) as treatment for acute respiratory failure due to its lower complication rate, but NIV may still be associated with serious complications such as nosocomial pneumonia. However, risk factors associated with NIV-associated pneumonia remain insufficiently characterized.

OBJECTIVE

To investigate factors associated with NIV-associated pneumonia in patients treated with NIV for acute respiratory failure in a respiratory intensive care unit.

METHOD: In this prospective cohort study, we followed adult patients who were admitted to a respiratory intensive care unit in a tertiary hospital for acute respiratory failure. None of the patients had pneumonia on admission. All patients were treated with NIV and monitored daily for the development of nosocomial pneumonia, which was defined using standardized criteria. Multivariable logistic regression analysis was performed to identify factors independently associated with NIV-associated pneumonia.

RESULT: Among 191 eligible patients admitted between March 2023 and May 2024, 84 developed NIV-associated pneumonia. Age was not independently associated with pneumonia development. In multivariable analysis, poor oral hygiene, poor secretion control, and longer NIV duration were independently associated with NIV-associated pneumonia. Patients who developed pneumonia also had longer ICU stay and higher rates of antibiotic modification.

CONCLUSION

In patients receiving NIV for acute respiratory failure, poor oral hygiene, poor secretion control, and prolonged NIV exposure were independently associated with NIV-associated pneumonia, whereas chronological age, sepsis, and frailty were not. These findings suggest that clinical factors related to bedside care and NIV exposure may be more relevant to pneumonia development than age alone.