Prehospital non-invasive ventilation in acute respiratory failure is justified even if the distance to hospital is short
| Autor: | Nina Gagelmann, Thoralf Kerner, Sebastian Wirtz, Mike Sebastian Strunden, Sascha Tank, Mario Hensel |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Emergency Medical Services Acute exacerbation of chronic obstructive pulmonary disease Respiratory rate medicine.medical_treatment Pulmonary Edema Pulmonary Disease Chronic Obstructive 03 medical and health sciences 0302 clinical medicine Germany Positive airway pressure medicine Humans Non-invasive ventilation Prospective Studies 030212 general & internal medicine Continuous positive airway pressure Aged Aged 80 and over COPD Noninvasive Ventilation business.industry Hemodynamics 030208 emergency & critical care medicine General Medicine medicine.disease Hospitals Blood pressure Anesthesia Disease Progression Emergency Medicine Breathing Female Respiratory Insufficiency business |
| Zdroj: | The American Journal of Emergency Medicine. 37:651-656 |
| ISSN: | 0735-6757 |
| DOI: | 10.1016/j.ajem.2018.07.001 |
| Popis: | 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).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.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.).Prehospital NIV-treatment should be performed in patients with COPD-exacerbation and CPE, even if the distance between emergency scene and hospital is short. |
| Databáze: | OpenAIRE |
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