Prehospital continuous positive airway pressure (CPAP) for acute respiratory distress: a randomised controlled trial
Prehospital continuous positive airway pressure (CPAP) for acute respiratory distress: a randomised controlled trial
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院前持续气道正压通气（CPAP）治疗急性呼吸窘迫：一项随机对照试验
作者：
J. Finn;D. Brink;N. Mckenzie;Antón García;H. Tohira;G. Perkins;G. Arendts;D. Fatovich;D. Hendrie;B. McQuillan;Q. Summers;A. Celenza;Ashes Mukherjee;Ben Smedley;G. Pereira;S. Ball;T. Williams;P. Bailey
目的比较持续气道正压通气（CPAP）与常规护理对院前重度呼吸窘迫患者的疗效。方法我们于2016年3月至2018年12月在西澳大利亚州进行了一项平行组、个体患者、非盲随机对照试验。符合条件的患者年龄≥40岁，患有非创伤性急性重度呼吸窘迫，对急救医疗服务（EMS）护理人员的初始治疗无反应。患者随机（1：1）接受常规护理或常规护理加CPAP。主要结局是呼吸困难评分的变化和到达艾德时RR的变化以及住院时间。结果708例患者被随机分配（不透明密封信封）到常规护理组（n=346）或CPAP组（n=362）。与常规治疗相比，随机接受CPAP治疗的患者呼吸困难评分降低更大（常规护理-1.0，IQR-3.0至0.0 vs CPAP-3.5，IQR-5.2至2.0），中位差异-2.0（95% CI −2.5至−1.6）;和RR（常规护理−4.0，IQR −9.0至0.0 min-1 vs CPAP −8.0，IQR −14.0至−4.0 min-1），中位差异−4.0（95% CI −5.0至−4.0）min-1。对于n=624例住院病例，住院时间无差异（常规治疗4.2，IQR 2.1 - 7.8天vs CPAP 4.8，IQR 2.5 - 7.9天），中位差异为0.36（95% CI-0.17 - 0.90）。结论EMS护理人员使用院前CPAP可减少急性呼吸窘迫患者的呼吸困难和呼吸急促，但不影响住院时间。试验注册号ACTRN 12615001180505。
Objective To compare the efficacy of continuous positive airway pressure (CPAP) versus usual care for prehospital patients with severe respiratory distress. Methods We conducted a parallel group, individual patient, non-blinded randomised controlled trial in Western Australia between March 2016 and December 2018. Eligible patients were aged ≥40 years with acute severe respiratory distress of non-traumatic origin and unresponsive to initial treatments by emergency medical service (EMS) paramedics. Patients were randomised (1:1) to usual care or usual care plus CPAP. The primary outcomes were change in dyspnoea score and change in RR at ED arrival, and hospital length of stay. Results 708 patients were randomly assigned (opaque sealed envelope) to usual care (n=346) or CPAP (n=362). Compared with usual care, patients randomised to CPAP had a greater reduction in dyspnoea scores (usual care −1.0, IQR −3.0 to 0.0 vs CPAP −3.5, IQR −5.2 to −2.0), median difference −2.0 (95% CI −2.5 to −1.6); and RR (usual care −4.0, IQR −9.0 to 0.0 min-1 vs CPAP −8.0, IQR −14.0 to −4.0 min-1), median difference −4.0 (95% CI −5.0 to −4.0) min-1. There was no difference in hospital length of stay (usual care 4.2, IQR 2.1 to 7.8 days vs CPAP 4.8, IQR 2.5 to 7.9 days) for the n=624 cases admitted to hospital, median difference 0.36 (95% CI −0.17 to 0.90). Conclusions The use of prehospital CPAP by EMS paramedics reduced dyspnoea and tachypnoea in patients with acute respiratory distress but did not impact hospital length of stay. Trial registration number ACTRN12615001180505.