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Observational Study
. 2019 Apr;37(4):651-656.
doi: 10.1016/j.ajem.2018.07.001. Epub 2018 Jul 2.

Prehospital non-invasive ventilation in acute respiratory failure is justified even if the distance to hospital is short

Mario Hensel  1 , Mike Sebastian Strunden  2 , Sascha Tank  3 , Nina Gagelmann  4 , Sebastian Wirtz  5 , Thoralf Kerner  6
Affiliations
Observational Study

Prehospital non-invasive ventilation in acute respiratory failure is justified even if the distance to hospital is short

Mario Hensel et al. Am J Emerg Med. 2019 Apr.

Abstract

Aims: Evaluation of the efficacy of prehospital non-invasive ventilation (NIV) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and cardiogenic pulmonary edema (CPE).

Material and methods: Consecutive patients who were prehospitally treated by Emergency Physicians using NIV were prospectively included. A step-by-step approach escalating NIV-application from continuous positive airway pressure (CPAP) to continuous positive airway pressure supplemented by pressure support (CPAP-ASB) and finally bilevel inspiratory positive airway pressure (BIPAP) was used. Patients were divided into two groups according to the prehospital NIV-treatment-time (NIV-group 1: ≤15 min, NIV-group 2: >15 min). In addition, a historic control group undergoing standard care was created. Endpoints were heart rate, peripheral oxygen saturation, breathing rate, systolic blood pressure, and a dyspnea score.

Results: A total of 99 patients were analyzed (NIV-group 1: n = 41, NIV-group 2: n = 58). The control group consisted of 30 patients. The majority of NIV-patients (90%) received CPAP-ASB, while CPAP without ASB was conducted in 8% and BIPAP-ventilation in 2% of all cases. Technical application of NIV lasted 6.1 ± 3.8 min. NIV-treatment-time was as follows: NIV-group 1: 13.1 ± 3.2 min, NIV-group 2: 22.8 ± 5.9 min. Differences between baseline- and hospital admission values of all endpoints showed significantly better improvement in NIV-groups compared to the control group (p < 0.001). The stabilizing effect of NIV in terms of vital parameters was comparable between both NIV-groups, independent of the duration of treatment (n.s.).

Conclusion: Prehospital NIV-treatment should be performed in patients with COPD-exacerbation and CPE, even if the distance between emergency scene and hospital is short.

Keywords: Acute respiratory failure; Cardiogenic pulmonary edema; Chronic obstructive pulmonary disease; Non-invasive ventilation; Prehospital care.

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