Noninvasive Positive Pressure Ventilation: Resource Document for the National Association of EMS Physicians Position Statement

Daily, Josiah C.; Wang, Henry E.

doi:10.3109/10903127.2011.569851

Cited by 21 publications

(11 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…7 Prehospital NIV is considered in some guidelines, 8,9 but widespread use is limited by the need for additional training and equipment and may be informed by robust evidence of clinical effectiveness and cost-effectiveness.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] It involves providing respiratory support through a tight-fitting mask that is usually applied around the patient's mouth and nose and may take the form of continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP), including noninvasive pressure support ventilation. It is normally used in the hospital, but it may be more effective if treatment is commenced prior to arrival.7 Prehospital NIV is considered in some guidelines, 8,9 but widespread use is limited by the need for additional training and equipment and may be informed by robust evidence of clinical effectiveness and cost-effectiveness.Prehospital NIV has been evaluated in a number of studies, which have been summarized in systematic reviews [10][11][12] and meta-analysis. 13,14 These suggest that prehospital NIV, and specifically prehospital CPAP, can improve outcomes.…”

mentioning

confidence: 99%

“…It is normally used in the hospital, but it may be more effective if treatment is commenced prior to arrival. 7 Prehospital NIV is considered in some guidelines, 8,9 but widespread use is limited by the need for additional training and equipment and may be informed by robust evidence of clinical effectiveness and cost-effectiveness.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Prehospital Noninvasive Ventilation for Acute Respiratory Failure: Systematic Review, Network Meta‐analysis, and Individual Patient Data Meta‐analysis

Goodacre

Stevens

Pandor

et al. 2014

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: This meta-analysis aimed to determine the effectiveness of prehospital continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP) in acute respiratory failure.Methods: Fourteen electronic databases and research registers were searched from inception to August 2013. Randomized or quasi-randomized controlled trials that reported mortality or intubation rate for prehospital CPAP or BiPAP were selected and compared to a relevant comparator in patients with acute respiratory failure. An aggregate data network meta-analysis was used to jointly estimate intervention effects relative to standard care. A network meta-analysis using a mixture of individual patient-level data and aggregate data was carried out to assess potential treatment effect modifiers.Results: Eight randomized and two quasi-randomized controlled trials (six CPAP, four BiPAP, sample sizes 23 to 207) were identified. The aggregate data network meta-analysis suggested that CPAP was the most effective treatment in terms of mortality (probability = 0.989) and intubation rate (probability = 0.639) and reduced both mortality (odds ratio [OR] = 0.41; 95% credible interval [CrI] = 0.20 to 0.77) and intubation rate (OR = 0.32; 95% CrI = 0.17 to 0.62), compared to standard care. The effect of BiPAP on mortality (OR = 1.94; 95% CrI = 0.65 to 6.14) and intubation rate (OR = 0.40; 95% CrI = 0.14 to 1.16) was uncertain. The network meta-analysis using individual patient-level data and aggregate data suggested that sex was a modifier of the effect of treatment on mortality. A cute respiratory failure is a common but lifethreatening medical emergency, especially in elderly patients with respiratory and cardiac diseases. [1][2][3] It is caused by a number of common cardiac or respiratory conditions, including heart failure, pneumonia, and exacerbation of chronic obstructive pulmonary disease. The definitive treatment of acute respiratory failure depends on the underlying cause, but patients often require prehospital treatment. At this point it is difficult to accurately determine the underlying cause, so prehospital treatment of acute respiratory failure often follows a common pathway, rather than being specific to the underlying cause. ConclusionsNoninvasive ventilation (NIV) can be used to treat acute respiratory failure. [4][5][6] It involves providing respiratory support through a tight-fitting mask that is usually applied around the patient's mouth and nose and may take the form of continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP), including noninvasive pressure support ventilation. It is normally used in the hospital, but it may be more effective if treatment is commenced prior to arrival.7 Prehospital NIV is considered in some guidelines, 8,9 but widespread use is limited by the need for additional training and equipment and may be informed by robust evidence of clinical effectiveness and cost-effectiveness.Prehospital NIV has been evaluated in a number o...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Prehospital Noninvasive Ventilation for Acute Respiratory Failure: Systematic Review, Network Meta‐analysis, and Individual Patient Data Meta‐analysis

Goodacre

Stevens

Pandor

et al. 2014

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…In the USA, the National Association of Emergency Medical Service Physicians stated that NIV is an important treatment modality for the pre-hospital management of acute dyspnoea. 37 In the UK, it was identified among research priorities by a recent 999 emergency medical services research forum. 38 With around 16,000 paramedics and 5500 ambulance vehicles in England, widespread adoption of NIV into paramedic practice would require substantial resources of training and equipment.…”

Section: Description Of the Technology Under Assessmentmentioning

confidence: 99%

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

Pandor

Thokala

Goodacre

et al. 2015

Health Technol Assess

View full text Add to dashboard Cite

BackgroundNon-invasive ventilation (NIV), in the form of continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP), is used in hospital to treat patients with acute respiratory failure. Pre-hospital NIV may be more effective than in-hospital NIV but requires additional ambulance service resources.ObjectivesWe aimed to determine the clinical effectiveness and cost-effectiveness of pre-hospital NIV compared with usual care for adults presenting to the emergency services with acute respiratory failure and to identify priorities for future research.Data sourcesFourteen electronic databases and research registers (including MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature) were searched from inception to August 2013, supplemented by hand-searching reference lists and contacting experts in the field.Review methodsWe included all randomised or quasi-randomised controlled trials of pre-hospital NIV in patients with acute respiratory failure. Methodological quality was assessed according to established criteria. An aggregate data network meta-analysis (NMA) of mortality and intubation was used to jointly estimate intervention effects relative to usual care. A NMA, using individual patient-level data (IPD) and aggregate data where IPD were not available, was carried out to assess whether or not covariates were treatment effect modifiers. A de novo economic model was developed to explore the costs and health outcomes when pre-hospital NIV (specifically CPAP provided by paramedics) and standard care (in-hospital NIV) were applied to a hypothetical cohort of patients with acute respiratory failure.ResultsThe literature searches identified 2284 citations. Of the 10 studies that met the inclusion criteria, eight were randomised controlled trials and two were quasi-randomised trials (six CPAP; four BiPAP; sample sizes 23–207 participants). IPD were available from seven trials (650 patients). The aggregate data NMA suggested that CPAP was the most effective treatment in terms of mortality (probability = 0.989) and intubation rate (probability = 0.639), and reduced both mortality [odds ratio (OR) 0.41, 95% credible interval (CrI) 0.20 to 0.77] and intubation rate (OR 0.32, 95% CrI 0.17 to 0.62) compared with standard care. The effect of BiPAP on mortality (OR 1.94, 95% CrI 0.65 to 6.14) and intubation rate (OR 0.40, 95% CrI 0.14 to 1.16) compared with standard care was uncertain. The combined IPD and aggregate data NMA suggested that sex was a statistically significant treatment effect modifier for mortality. The economic analysis showed that pre-hospital CPAP was more effective and more expensive than standard care, with an incremental cost-effectiveness ratio of £20,514 per quality-adjusted life-year (QALY) and a 49.5% probability of being cost-effective at the £20,000-per-QALY threshold. Variation in the incidence of eligible patients had a marked impact on cost-effectiveness and the expected value of sample information for a future randomised trial.LimitationsThe meta-analysis lacked power to detect potentially important differences in outcome (particularly for BiPAP), the intervention was not always compared with the best alternative care (in-hospital NIV) in the primary studies and findings may not be generalisable.ConclusionsPre-hospital CPAP can reduce mortality and intubation rates, but cost-effectiveness is uncertain and the value of further randomised evaluation depends on the incidence of suitable patients. A feasibility study is required to determine if a large pragmatic trial of clinical effectiveness and cost-effectiveness is appropriate.Study registrationThe study is registered as PROSPERO CRD42012002933.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

“…1 Although it is considered in guidelines, the need for additional trained health workers, special equipment, and clinical evidence for effectiveness and cost-effectiveness limits widespread use. 1,2 The Boussignac CPAP facial mask is a compact CPAP system that has been used frequently in emergency services. 3,4 This system is simple, safe, and portable and requires only an oxygen source, so it can be used easily by paramedical personnel.…”

Section: To the Editormentioning

confidence: 99%

CPAP Devices for Emergency Prehospital Use: Looking Inside of It

Saltürk

Esquinas

2016

Respir Care

View full text Add to dashboard Cite

Prehospital use of CPAP reduces the mortality and intubation rate for patients with acute respiratory failure especially due to acute cardiogenic pulmonary edema. 1 Although it is considered in guidelines, the need for additional trained health workers, special equipment, and clinical evidence for effectiveness and cost-effectiveness limits widespread use. 1,2 The Boussignac CPAP facial mask is a compact CPAP system that has been used frequently in emergency services. 3,4 This system is simple, safe, and portable and requires only an oxygen source, so it can be used easily by paramedical personnel. Also, Boussignac CPAP has been shown to be effective for acute cardiogenic pulmonary edema in the emergency department. 3,4 We read with great interest the RESPIRA-TORY CARE article by Brusasco et al 5 entitled "CPAP devices for emergency prehospital use: a bench study." The study evaluated and compared on a bench model the performance of 3 orofacial mask devices (Ventumask, EasyVent, and Boussignac CPAP system) and 2 helmets (Ventukit and EVE Coulisse). The efficiency of the devices was compared based on oxygen flow needed to generate a minimum air flow of 60 L/min at each CPAP setting. The authors found that only the EasyVent and EVE Coulisse achieved the required minimum level of air flow output needed to ensure an effective therapy under all CPAP conditions. This study definitely requires attention, since it provides valuable information for clinicians and prehospital medical staff about specific device performance features to optimize effective application of CPAP in prehospital and emergency settings. However, we think that there are some issues that deserve comment.First, information about or comparisons of the cost of these devices were not given.It is essential to demonstrate the cost-effectiveness of prehospital CPAP to ensure its widespread clinical use. Cost-effective treatment strategies for acute cardiogenic pulmonary edema are needed to avoid the need for intubation and mechanical ventilation. Hubble et al 6 did a study to estimate costeffectiveness of CPAP in managing prehospital acute cardiogenic pulmonary edema in an urban medical emergency system. They calculated and compared prehospital CPAP costs with hospitalization costs, including ICU stay. CPAP equipment constitutes the largest portion of calculated prehospital costs. Based on the theoretical cost-effectiveness analysis, they concluded that CPAP is a cost-effective prehospital treatment. The authors in this study obviously gave technical information and bench test results for these devices. However, we think that brief information about and comparison of the cost should be given, although this is not included in the aim of the study.Second, we think that bench test effectiveness and efficacy of these devices cannot be adapted to clinical events. Not only the known patient-dependent variabilities of noninvasive ventilation but also prehospital application with its own difficulties and factors should be considered. The authors simulated tidal vo...

show abstract

Noninvasive Positive Pressure Ventilation: Resource Document for the National Association of EMS Physicians Position Statement

Abstract: The National Association of EMS Physicians (NAEMSP) believes that noninvasive positive pressure ventilation (NIPPV) is an important treatment modality for the prehospital management of acute dyspnea. This document serves as a resource to the NAEMSP position on prehospital NIPPV.

Cited by 21 publications

References 63 publications

Prehospital Noninvasive Ventilation for Acute Respiratory Failure: Systematic Review, Network Meta‐analysis, and Individual Patient Data Meta‐analysis

Prehospital Noninvasive Ventilation for Acute Respiratory Failure: Systematic Review, Network Meta‐analysis, and Individual Patient Data Meta‐analysis

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

CPAP Devices for Emergency Prehospital Use: Looking Inside of It

Contact Info

Product

Resources

About