Use of bilevel positive airway pressure in out-of-hospital patients.
OBJECTIVE: To evaluate the utility of bilevel positive airway pressure (BiPAP) in the out-of-hospital treatment of patients with presumed congestive heart failure (CHF). METHODS: This was a prospective, sequential, parallel trial in an urban setting served by a single emergency medical services (EMS) system between January 4 and April 15, 1999. A convenience sampling of adults who were transported by rescue units judged to be in CHF by treating emergency medical technicians trained in advanced life support ( ALS EMTs) was included. Rescue squads were divided into demographically matched pairs, and one of each was equipped with a BiPAP ventilatory support unit. Bilevel positive airway pressure therapy was added to the existing treatment protocols for eligible study patients. Main outcome measures were out-of-hospital treatment time, oxygen saturation changes, hospitalization length, need for endotracheal intubation, mortality rate, and ease of use of the device by EMS personnel. RESULTS: Sixty-two of 71 enrolled patients completed the study. Out-of-hospital treatment times did not differ between groups (31.2 minutes vs 31.4 minutes; p = 0.931). The difference between pre- and post-treatment oxygen saturation levels was greater for the BiPAP group (13.71%) than the control group (6.69%) (p < 0.05). There was no statistical difference between groups in the length of hospital stay [control: 7.63 days, vs BiPAP: 6.33 days, p = 0.48], the intubation rate [control: 7 of 25 (28%) vs BiPAP: 4 of 37 (11%), p = 0.10], or death rate [control: 2 of 24, vs BiPAP: 6 of 37, p = 0.46]. All of the ALS EMTs who used BiPAP thought that it was safe to use, and 97% thought it was easy and appeared to improve patients' dyspnea and respiratory distress. CONCLUSIONS: ALS EMTs can be trained to deliver noninvasive ventilation with BiPAP, find it easy to apply, and believe that it helps relieve dyspnea in patients with suspected CHF.[1]References
- Use of bilevel positive airway pressure in out-of-hospital patients. Craven, R.A., Singletary, N., Bosken, L., Sewell, E., Payne, M., Lipsey, R. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. (2000) [Pubmed]
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