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Management of critical illness with non-invasive ventilation by an Australian HEMS
  1. Andrew R Coggins1,2,
  2. Erin N Cummins1,
  3. Brian Burns2,3
  1. 1Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia
  2. 2Discipline of Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia
  3. 3Ambulance Service of New South Wales, Greater Sydney Area HEMS, Sydney, New South Wales, Australia
  1. Correspondence to
    Dr Andrew Coggins, Department of Emergency Medicine, Westmead Emergency, Hawkesbury Rd, Sydney, NSW 2145, Australia; andrewrcoggins{at}gmail.com

Abstract

Background Non-invasive ventilation (NIV) therapy is widely used for the management of acute respiratory failure. The objective of this study was to investigate the current use of NIV during interhospital retrievals in an Australian physician-led aeromedical service.

Methods We reviewed patients receiving NIV during interhospital retrieval at the Greater Sydney Area Helicopter Medical Services (GSA-HEMS) over a 14-month period. The main objectives were to describe the number of retrievals using NIV, the need for intubation in NIV patients and the effect of the therapy on mission duration.

Results Over the study period, 3018 missions were reported; 106 cases (3.51%) involved administration of NIV therapy during the retrieval. The most common indication for NIV was pneumonia (34.0%). 86/106 patients received a successful trial of NIV therapy prior to interhospital transfer. 58 patients were transferred on NIV, while 28 patients had NIV removed during transport. None of these 86 patients required intubation or died, although 17/86 ultimately required intubation within 24 hours at the receiving centre. 20/106 patients required intubation at the referring hospital after a failed trial of NIV therapy. NIV was successfully used in all available transport platforms including rotary wing. Patients receiving NIV were found to have prolonged mission durations compared with other GSA-HEMS patients (222.5 vs 193 min). This increase in mission duration was largely attributable to NIV failure, resulting in a need for Rapid Sequence Intubation at the referring hospital.

Conclusions With careful patient selection, the use of interhospital NIV is feasible and appears to be safe in a retrieval system with care provided by a critical care physician.

  • ventilation, non invasive
  • prehospital care, clinical management
  • emergency care systems, remote and rural medicine

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Correction notice Since this paper was first published online table 3 has been modified. The transit time data in the ‘All NIV cases (n=106)’ column has been updated. It now reads 39.5 (30–62).

  • Twitter Follow Andrew Coggins at @coggi33

  • Contributors ARC and BB conceived the study. ARC extracted data from the electronic medical record, which was crosschecked by ENC and BB. BB and ARC performed the data analysis. All authors contributed to and have approved the final manuscript.

  • Competing interests None declared.

  • Ethics approval Westmead Hospital Ethics Committee.

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

  • Data sharing statement Data are provided in full in the results section of this paper. Non-digital materials supporting this study are stored securely by the corresponding author at the University of Sydney. Data are available from AC upon request.

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