• Am J Emerg Med · Apr 2019

    Observational Study

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

    • Mario Hensel, Mike Sebastian Strunden, Sascha Tank, Nina Gagelmann, Sebastian Wirtz, and Thoralf Kerner.
    • Department of Anesthesiology and Intensive Care Medicine, Park-Klinik-Weissensee, Schönstrasse 80, 13086 Berlin, Germany. Electronic address: hensel@park-klinik.com.
    • Am J Emerg Med. 2019 Apr 1; 37 (4): 651-656.

    AimsEvaluation 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 MethodsConsecutive 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.ResultsA 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.).ConclusionPrehospital NIV-treatment should be performed in patients with COPD-exacerbation and CPE, even if the distance between emergency scene and hospital is short.Copyright © 2018 Elsevier Inc. All rights reserved.

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