ASSESSMENT OF THE ADDITION OF PREHOSPITAL CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) TO AN URBAN EMERGENCY MEDICAL SERVICES (EMS) SYSTEM IN PERSONS WITH SEVERE RESPIRATORY DISTRESS
ASSESSMENT OF THE ADDITION OF PREHOSPITAL CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) TO AN URBAN EMERGENCY MEDICAL SERVICES (EMS) SYSTEM IN PERSONS WITH SEVERE RESPIRATORY DISTRESS
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DOI：
10.1016/j.jemermed.2013.01.044
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发表时间：
2013-08-01
影响因子：
1.5
通讯作者：
Serra, John
中科院分区：
文献类型：
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作者：
Aguilar, Steve A.;Lee, Jonathon;Serra, John
背景：持续气道正压(CPAP)辅助呼吸机在院前环境中的应用尚未得到很好的研究。目的：本研究的目的是评估将院前CPAP添加到城市紧急医疗服务(EMS)呼吸窘迫方案中对呼吸窘迫患者的有效性。方法：对2005-2010年间连续就诊的EMS患者进行历史队列分析。在呼吸窘迫的严重程度上，两组进行了匹配。生理变量是急诊科急救人员和分诊后获得的主要结果。其他结果包括气管插管率、住院死亡率、总住院时间(LOS)、重症监护病房(ICU)入院和ICU LOS。结果：共有410名符合严重呼吸窘迫标准的连续患者进入研究，235名历史对照与175名实施后的患者相匹配。他们的平均年龄为67岁，其中54%是男性。心率和呼吸率的中位数差异显著，有利于历史队列(均P<；0.05)。在插管率、总住院日、ICU住院率、ICU日住院率和住院死亡率方面没有显著差异(均P>；0.05)。继续接受无创呼吸机辅助的患者插管率和ICU LOS显著改善(均P<；0.05)。结论：在EMS院前呼吸窘迫治疗方案中加入CPAP可改善心跳和呼吸频率。虽然没有统计学意义，但观察到总体LOS和ICU LOS有所下降。持续呼吸机辅助的患者插管率和ICU LOS似乎有所改善。(C)2013年爱思唯尔公司。
Background: The use of continuous positive airway pressure (CPAP)-assisted ventilation in the prehospital setting has not been well studied. Objectives: The purpose of this study was to measure the efficacy of adding prehospital CPAP to an urban emergency medical services (EMS) respiratory distress protocol for persons with respiratory distress. Methods: An historical cohort analysis of consecutive EMS patients presenting during the years 2005-2010. Groups were matched for severity of respiratory distress. Physiologic variables were the primary outcomes obtained from first responders and upon triage in the Emergency Department. Additional outcomes included endotracheal intubation rate, hospital mortality, overall hospital length of stay (LOS), intensive care unit (ICU) admission, and ICU LOS. Results: There were a total of 410 consecutive patients with predetermined criteria for severe respiratory distress, 235 historical controls matched with 175 post-implementation patients, entered in the study. The average age was 67 years; 54% were men. There were significant median differences in heart and respiratory rates favoring the historical cohort (all p < 0.05). There were no significant differences in intubation rate, overall hospital LOS, ICU admission rate, ICU LOS, or hospital mortality (all p > 0.05). Patients who were continued on non-invasive ventilatory assistance had a significantly improved rate of intubation and ICU LOS (all p < 0.05). Conclusion: The addition of CPAP to an EMS prehospital respiratory distress protocol resulted in improved heart and respiratory rates. Though not statistically significant, decrease in overall and ICU LOS were observed. Patients with continued ventilatory assistance seemed to have improved rates of intubation and ICU LOS. (C) 2013 Elsevier Inc.