Article Text

PDF

Early prehospital use of non-invasive ventilation improves acute respiratory failure in acute exacerbation of chronic obstructive pulmonary disease
  1. Willi Schmidbauer1,
  2. Olaf Ahlers2,
  3. Claudia Spies2,
  4. Anke Dreyer1,
  5. Georg Mager3,
  6. Thoralf Kerner2,4
  1. 1Department of Emergency Medicine, Bundeswehrkrankenhaus Berlin, Berlin, Germany
  2. 2Department of Anaesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
  3. 3Bundeswehrkrankenhaus Koblenz, Koblenz, Germany
  4. 4Department of Anaesthesiology and Intensive Care Medicine, Asklepios Klinik Harburg, Hamburg, Germany
  1. Correspondence to Dr Olaf Ahlers, Department of Anaesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Augustenburger Platz 1, 13353 Berlin, Germany; olaf.ahlers{at}charite.de

Abstract

Aim To evaluate the use of prehospital non-invasive ventilation (NIV) in patients with acute exacerbation of chronic obstructive pulmonary disease.

Methods 36 adult patients were treated by prehospital NIV or standard oxygen therapy.

Results Prehospital NIV was described as feasible by the paramedics. Prehospital improvement of respiratory rate and dyspnoea was significantly better and the length of intensive care was significantly lower in NIV patients.

Conclusion Prehospital NIV can be managed by a trained emergency team with high but sustainable workload. Dyspnoea and length of intensive care may be significantly reduced.

Clinical trial registration number ISRCTN47620321.

Statistics from Altmetric.com

Non-invasive ventilation (NIV) is used as ventilatory support and has been demonstrated to be effective in the treatment of several forms of respiratory failure in intensive care or during in-hospital emergency care.1–5 Only few studies have described the prehospital benefit of NIV for patients with acute cardiogenic pulmonary oedema.6–8 The aim of this study was to evaluate the practicability and efficacy of prehospital NIV in patients with acute exacerbated chronic obstructive pulmonary disease (COPD).

Methods

Inclusion criteria (age ≥18 years, acute dyspnoea, respiratory rate (RR) >25 breaths/min, pulse oxymetric oxygen saturation (SpO2) <90%) were fulfilled by 36 out of 174 screened prehospital patients with acute exacerbation of COPD over a study period of 1 year.

Patients underwent sealed envelope random assignment to prehospital NIV (Oxylog 3000; Dräger, Germany) by face mask (n=18) or standard oxygen therapy by face mask (control group, n=18), respectively. All patients received additional therapy by an emergency physician according to local standard operating procedures. Prehospital monitoring included a dyspnoea score, which measures dyspnoea as declared by the patient with a range from 1 (no dyspnoea) to 10 (worst dyspnoea).9

In both groups endotracheal intubation was performed according to the physician's decision. These patients were excluded from further prehospital analyses.

Differences in baseline and admission values of SpO2, RR, dyspnoea score, heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated for each patient, respectively. Distinctions between the groups were analysed by Fisher's exact test for nominal scaled data and the Mann–Whitney test for other data.

Results

No significant differences could be found between both groups concerning sex, age, height, weight and SpO2, RR, dyspnoea score, HR, SBP and DBP at baseline.

Prehospital NIV was estimated as feasible by the paramedics and additional expenditure of time at the site of emergency was specified as 8 (5–10) min.

One patient in the NIV group needed endotracheal intubation and was therefore excluded from prehospital analyses.

In both groups RR, dyspnoea score, SBP and DBP, HR and SpO2 improved from baseline to hospital admission.

Analysis of differences of baseline and admission values revealed significantly better improvement of RR (p=0.001) and dyspnoea score (p<0.001) in the NIV group. Improvement of SpO2 was more pronounced in the NIV group, but failed to reach the level of significance (figure 1, p=0.19). No significant differences between both groups could be found with respect to changes in HR, SBP and DBP.

Figure 1

Difference in baseline and admission values. *Significant difference between both groups. NIV, non-invasive ventilation; SpO2, pulse oxymetric oxygen saturation.

All patients survived. The length of intensive care was significantly lower in NIV patients (see table 1).

Table 1

In-hospital course and endotracheal intubation during first 24 h

Discussion

Early prehospital NIV significantly improved dyspnoea in our patients. This result is in accordance with data from other groups.6 7 Reduced dyspnoea means reduced stress reactions and may thus prevent a switch to the humoral immune response, which would diminish the state of COPD patients.10

Early prehospital NIV significantly shortened intensive care as already described for emergency department patients.5 Considering costs of €1000 per day of intensive care, our results indicate a cost reduction from €7708 (median 185 h) without prehospital NIV to €2458 (median 59 h) with prehospital NIV.

In conclusion, prehospital NIV can be managed by a trained emergency team with high but sustainable workload. Dyspnoea and the length of intensive care may be significantly reduced.

References

View Abstract

Footnotes

  • WS and OA contributed equally to this study.

  • Funding This study was funded by the medical service of the German armed forces.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Institutional Ethics Committee, Charite Universitätsmedizin, Berlin.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.