Prehospital treatment with continuous positive airway pressure in patients with acute respiratory failure: a regional observational study.
Prehospital treatment with continuous positive airway pressure in patients with acute respiratory failure: a regional observational study.
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DOI：
10.1186/s13049-016-0315-3
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发表时间：
2016-10-10
期刊：
影响因子：
--
通讯作者：
Christensen EF
中科院分区：
文献类型：
--
作者：
Nielsen VM;Madsen J;Aasen A;Toft-Petersen AP;Lübcke K;Rasmussen BS;Christensen EF
急性呼吸衰竭患者在院前转运期间面临病情恶化的风险。可以在院前环境中启动持续气道正压通气 (CPAP) 的通气支持。该研究的目的是评估 CPAP 治疗的依从性和作为标准护理补充的有效性。在丹麦北部地区，2014 年 3 月 1 日至 2015 年 5 月 3 日期间，护理人员评估为患有急性心肺水肿、慢性阻塞性肺病急性加重或哮喘的急性呼吸衰竭患者接受使用 100% O2 的 CPAP 治疗。治疗依从性通过不良事件和停止治疗的数量进行评估。该队列报告了重症监护入院率和死亡率。通过运输过程中外周血氧饱和度 (SpO2) 和呼吸频率的变化来评估有效性，并与仅接受标准护理治疗的历史对照组（非 CPAP）进行比较。通过到达现场时 SpO2 的假设检验和线性模型以及根据治疗组分层的 ΔSpO2 来比较值。在 14 个月内，171 名患者接受了 CPAP 治疗（平均治疗时间 35±18 分钟）。 15 名患者 (9%) 报告了不良事件，其中 6 名患者因低血压、恶心或呼吸困难恶化而停止了 CPAP。据报道，发生了一起严重不良事件，即疑似气胸，并由移动急救中心的麻醉师进行了充分治疗。在 CPAP 患者中，45 例 (27%) 被送入重症监护室，24 例 (14%) 在出院前死亡。非 CPAP 组由 739 名患者组成。从到达现场到到达医院，CPAP 患者的 SpO2 比非 CPAP 患者的 SpO2 增加幅度更大（87 至 96% vs 92 至 96%，p< 0.01），呼吸频率下降幅度更大（32 至 25 次呼吸/分钟 vs 28 至 24 次呼吸/分钟，p< 0.01）。在线性模型中，对于初始 SpO2 ≤90 % 的患者，CPAP 优于非 CPAP（p < 0.05）。一名 CPAP 患者 (0.6%) 和八名非 CPAP 患者 (1.1%) 在院前接受插管。该研究设计反映了院前的日常工作环境，包括较长的运输时间和接受过治疗急性呼吸衰竭症状教育的护理人员，而不是治疗一种特定的诊断。研究人群是连续纳入的，很少有患者失访。然而，该研究规模太小，无法评估院前 CPAP 对死亡率的任何影响，也无法检查其在特定疾病条件下的有效性。在包括医生后备在内的紧急医疗服务中，护理人员对 CPAP 治疗的依从性很高，并且对急性呼吸衰竭患者的治疗有效。
Patients with acute respiratory failure are at risk of deterioration during prehospital transport. Ventilatory support with continuous positive airway pressure (CPAP) can be initiated in the prehospital setting. The objective of the study is to evaluate adherence to treatment and effectiveness of CPAP as an addition to standard care. In North Denmark Region, patients with acute respiratory failure, whom paramedics assessed as suffering from acute cardiopulmonary oedema, acute exacerbation of chronic obstructive pulmonary disease or asthma were treated with CPAP using 100 % O2 from 1 March 2014 to 3 May 2015. Adherence to treatment was evaluated by number of adverse events and discontinuation of treatment. Intensive care admissions and mortality were reported in this cohort. Effectiveness was evaluated by changes in peripheral oxygen saturation (SpO2) and respiratory rate during transport and compared to a historical control (non-CPAP) group treated with standard care only. Values were compared by hypothesis testing and linear modelling of SpO2 on arrival at scene and ΔSpO2 stratified according to treatment group. In fourteen months, 171 patients were treated with CPAP (mean treatment time 35 ± 18 min). Adverse events were reported in 15 patients (9 %), hereof six discontinued CPAP due to hypotension, nausea or worsening dyspnoea. One serious adverse event was reported, a suspected pneumothorax treated adequately by an anaesthesiologist called from a mobile emergency care unit. Among CPAP patients, 45 (27 %) were admitted to an intensive care unit and 24 (14 %) died before hospital discharge. The non-CPAP group consisted of 739 patients. From arrival at scene to arrival at hospital, CPAP patients had a larger increase in SpO2 than non-CPAP patients (87 to 96 % versus 92 to 96 %, p < 0.01) and a larger decrease in respiratory rate (32 to 25 versus 28 to 24 breaths/min, p < 0.01). In a linear model, CPAP was superior to non-CPAP in patients with initial SpO2 ≤90 % (p < 0.05). One CPAP patient (0.6 %) and eight non-CPAP patients (1.1 %) were intubated in the prehospital setting. The study design reflects the daily prehospital working environment including long transport timesand paramedics educated in treating symptoms of acute respiratory failure, rather than treating one specific diagnosis. The study population was included consecutively and few patients were lost to follow-up. However, the study was too small to allow assessment of any effect of prehospital CPAP on mortality, nor could the effectiveness in specific disease conditions be examined. In an emergency medical service including physician backup, adherence to CPAP treatment administered by paramedics was high and treatment was effective in patients with acute respiratory failure.
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DOI：
10.1186/cc4926
发表时间：
2006
期刊：
Critical care (London, England)
影响因子：
--
作者：
Ray P;Birolleau S;Lefort Y;Becquemin MH;Beigelman C;Isnard R;Teixeira A;Arthaud M;Riou B;Boddaert J
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DOI：
10.1186/1757-7241-21-53
发表时间：
2013-07-09
期刊：
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影响因子：
--
作者：
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Christensen EF
影响因子：
2.4
作者：
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影响因子：
1.5
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