Early prehospital use of non-invasive ventilation improves acute respiratory failure in acute exacerbation of chronic obstructive pulmonary disease

Abstract

ISRCTN47620321.

Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation

“…The design and patient characteristics of the 10 included studies [46][47][48][49][50][51][52][53][54][55] that evaluated the effectiveness of pre-hospital NIV for adults with acute respiratory failure are summarised in Tables 1-3 Of the 10 studies, only one study 55 recieved funding from one or more commercial sponsors. The design of the included studies required the continuation of management of respiratory failure in the hospital setting and in-hospital management was generally at the discretion of the treating physicians.…”

“…Of these, two studies 47,50 documented the exclusion of patients with COPD. Conversely, one study 52 included patients with acute respiratory failure due to COPD. One study 53 enrolled a diverse population, including patients with chronic heart failure, COPD, asthma, pneumonia and acute coronary syndrome with respiratory failure.…”

“…46 Continuous positive airway pressure was the most commonly used mode of NIV in the intervention arm of the included studies. While one study, that of Plaisance et al, 50 compared the effectiveness of early CPAP (where patients had CPAP for the first 15 minutes after study inclusion, followed by CPAP with medical treatment for 15 minutes) with late CPAP (where patients received conventional medical treatment with supplementary oxygen for the first 15 minutes of study inclusion, followed by the addition of CPAP for another 15 minutes), five studies [46][47][48]52,53 provided CPAP to patients in the intervention group while patients in the control group received conventional medical treatment only. Of the four studies 49,51,54,55 that assessed the use of BiPAP versus standard usual care, two were quasi-randomised trials.…”

“…47,48,[50][51][52]55 However, in the study by Thompson et al 53 the response to out-of-hospital emergency calls was the responsibility of an advanced life support team of paramedics, with ongoing online support provided by a physician, remotely. One study 46 had no information relating to medical personnel administering pre-hospital NIV.…”

“…Although two studies 46,49 did not provide details relating to the NIV interface or pressure support levels, eight studies 47,48,[50][51][52][53][54][55] used a face mask as the interface of choice for the administration of NIV. In RCTs evaluating CPAP, pressure levels were fixed at 7.5 cmH 2 O 50 or 10 cmH 2 O.…”