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Treatment of presumed acute cardiogenic pulmonary oedema in an ambulance system by nurses using Boussignac continuous positive airway pressure
  1. W Dieperink1,2,
  2. E E M Weelink3,
  3. I C C van der Horst1,
  4. R de Vos4,
  5. T Jaarsma1,
  6. L P H J Aarts3,
  7. F Zijlstra1,
  8. M W N Nijsten2
  1. 1
    Thoraxcenter, Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands
  2. 2
    Department of Critical Care, University Medical Center Groningen, University of Groningen, The Netherlands
  3. 3
    Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, The Netherlands
  4. 4
    AmbulanceZorg Groningen, University Medical Center Groningen, University of Groningen, The Netherlands
  1. Dr W Dieperink, Department of Critical Care, University Medical Center Groningen, University of Groningen, P O Box 30.001, 9700 RB Groningen, The Netherlands; w.dieperink{at}chir.umcg.nl

Abstract

Background: Early initiation of continuous positive airway pressure (CPAP) applied by face mask benefits patients with acute cardiogenic pulmonary oedema (ACPE). The simple disposable Boussignac CPAP (BCPAP) has been used in ambulances by physicians. In the Netherlands, ambulances are manned by nurses and not physicians. It was hypothesised that ambulance nurses are able to identify patients with ACPE and can successfully apply BCPAP. A prospective case series of patients with presumed ACPE treated with BCPAP by ambulance nurses is described.

Methods: After training of ambulance nurses, all 33 ambulances in the region were equipped with BCPAP. ACPE was diagnosed on clinical signs and pulse oximetry saturation (Spo2) <95%. BCPAP (5 cm H2O, Fio2 >80%) was generated with an oxygen flow of 15 l/min. The physiological responses, experiences and clinical outcomes of the patients were collected from ambulance and hospital records, and ambulance nurses and patients received a questionnaire.

Results: From March to December 2006, 32 patients (age range 61–94 years) received BCPAP during transport to six different regional hospitals. In 26 patients (81%) a diagnosis of ACPE was confirmed. With BCPAP, median (IQR) Spo2 increased from 79% (69–94%) to 96% (89–98%) within 20 min. The median (IQR) duration of BCPAP treatment was 26 min (21–32). The patients had no negative recollections of the treatment. Ambulance personnel were satisfied with the BCPAP therapy.

Conclusion: When applied by ambulance nurses, BCPAP was feasible and effective in improving oxygen saturation in patients with ACPE. Although survival benefit can only be demonstrated by further research, it is considered that BCPAP can be implemented in all ambulances in the Netherlands.

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Footnotes

  • Funding: This study was partly supported by a grant from the Office for Medical Technology Assessment and the Thoraxcenter, Department of Cardiology of the University Medical Center Groningen, University of Groningen, The Netherlands.

  • Competing interests: None.

  • Ethics approval: The study was approved by the Institutional Review Board (METc 2006.232) of the University Medical Center Groningen. Informed consent was obtained from patients to use their clinical data.

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