Non-invasive ventilation as a therapy option for acute exacerbations of chronic obstructive pulmonary disease and acute cardiopulmonary oedema in emergency medical services

• Verfasst von: Schmitt, Felix [VerfasserIn]
• Verfasst von: Gruneberg, Daniel [VerfasserIn]
• Verfasst von: Schneider, Niko [VerfasserIn]
• Verfasst von: Fögeling, Jan-Ole [VerfasserIn]
• Verfasst von: Leucht, Moritz [VerfasserIn]
• Verfasst von: Herth, Felix [VerfasserIn]
• Verfasst von: Preusch, Michael [VerfasserIn]
• Verfasst von: Schmidt, Werner [VerfasserIn]
• Verfasst von: Bopp, Christian [VerfasserIn]
• Verfasst von: Bruckner, Thomas [VerfasserIn]
• Verfasst von: Weigand, Markus A. [VerfasserIn]
• Verfasst von: Hofer, Stefan [VerfasserIn]
• Verfasst von: Popp, Erik [VerfasserIn]
• Titel: Non-invasive ventilation as a therapy option for acute exacerbations of chronic obstructive pulmonary disease and acute cardiopulmonary oedema in emergency medical services
• Verf.angabe: Felix C.F. Schmitt, Daniel Gruneberg, Niko R.E. Schneider, Jan-Ole Fögeling, Moritz Leucht, Felix Herth, Michael R. Preusch, Werner Schmidt, Christian Bopp, Thomas Bruckner, Markus A. Weigand, Stefan Hofer and Erik Popp
• E-Jahr: 2022
• Jahr: 29 April 2022
• Umfang: 13 S.
• Fussnoten: This article belongs to the Section Pulmonology ; Gesehen am 15.06.2022
• Titel Quelle: Enthalten in: Journal of Clinical Medicine
• Ort Quelle: Basel : MDPI, 2012
• Jahr Quelle: 2022
• Band/Heft Quelle: 11(2022), 9, Artikel-ID 2504, Seite 1-13
• ISSN Quelle: 2077-0383
• DOI: doi:10.3390/jcm11092504
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: acute cardiopulmonary oedema
• Sach-SW: acute exacerbated COPD
• Sach-SW: acute respiratory insufficiency
• Sach-SW: emergency medical service
• Sach-SW: prehospital non-invasive ventilation
• K10plus-PPN: 1807089541

Abstract

In this observational prospective multicenter study conducted between October 2016 and October 2018, we tested the hypothesis that the use of prehospital non-invasive ventilation (phNIV) to treat patients with acute respiratory insufficiency (ARI) caused by severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and acute cardiopulmonary oedema (ACPE) is effective, time-efficient and safe. The data were collected at four different physician response units and three admitting hospitals in a German EMS system. Patients with respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease and acute cardiopulmonary oedema were enrolled. A total of 545 patients were eligible for the final analysis. Patients were treated with oxygen supplementation, non-invasive ventilation or invasive mechanical ventilation. The primary outcomes were defined as changes in the clinical parameters and the in-hospital course. The secondary outcomes included time efficiency, peri-interventional complications, treatment failure rate, and side-effects. Oxygenation under phNIV improved equally to endotracheal intubation (ETI), and more effectively in comparison to standard oxygen therapy (SOT) (paO2 SOT vs. non-invasive ventilation (NIV) vs. ETI: 82 mmHg vs. 125 mmHg vs. 135 mmHg, p-value SOT vs. NIV < 0.0001). In a matched subgroup analysis phNIV was accompanied by a reduced time of mechanical ventilation (phNIV: 1.8 d vs. ETI: 4.2 d) and a shortened length of stay at the intensive care unit (3.4 d vs. 5.8 d). The data support the hypothesis that the treatment of severe AECOPD/ACPE-induced ARI using prehospital NIV is effective, time efficient and safe. Compared to ETI, a matched comparison supports the hypothesis that prehospital implementation of NIV may provide benefits for an in-hospital course.