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Title: Prehospital noninvasive ventilation: a viable treatment option in the urban setting.
Austin Authors: Taylor, David McD ;Bernard, Stephen A;Masci, Kevin;MacBean, Catherine E;Kennedy, Marcus P;Zalstein, Salomon
Affiliation: Emergency Medicine Research, Austin Health, Heidelberg, Victoria Australia
Issue Date: 3-Jan-2008
Publication information: Prehospital Emergency Care : Official Journal of the National Association of Ems Physicians and the National Association of State Ems Directors; 12(1): 42-5
Abstract: To determine the viability of prehospital noninvasive ventilation (NIV) as a prelude to a definitive clinical trial.This was a retrospective observational study of patients (aged > 55 years, severe shortness of breath) transported to a tertiary emergency department (10/5/03-12/28/04). Data were extracted from paramedic and hospital medical records. The primary outcome measure was the number of patients who could potentially benefit from prehospital NIV. They were defined as "conscious upon paramedic arrival and who required ventilatory support (bag/valve/mask ventilation [BVM], NIV or endotracheal intubation) during transport or within 30 minutes of arrival at the emergency department (ED)." The secondary outcome measures were the effectiveness of existing paramedic treatment regimens and paramedic management times.Two hundred sixty-four patients were enrolled (mean age 75.5 +/- 8.7 years, 59.1% male). Sixty-seven patients (25.4%, 95% CI: 20.3-31.2) met the primary outcome measure: 31 (11.7%, 95% CI: 8.2-16.4) received prehospital BVM, an additional 35 (13.3%, 95% CI: 9.5-18.1) received NIV in the ED and one (0.4%, 95% CI: 0.0-2.4) was intubated in the ED. Prehospital treatment resulted in significant (p < 0.001) improvements in systolic blood pressure (151.2 dropping to 144.2 mmHg), respiratory rate (29.4 dropping to 26.3 breaths/minute), and oxygen saturation (92.3% rising to 96.2%). Median paramedic management time was 33 minutes (IQR 29-40).Prehospital treatment significantly improved patient vital signs. However, a considerable proportion of patients still required ventilatory support either prehospital or early in their ED course. Further research is indicated to determine if these patients would benefit from prehospital NIV.
Gov't Doc #: 18189176
DOI: 10.1080/10903120701710389
Journal: Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
Type: Journal Article
Subjects: Aged
Continuous Positive Airway Pressure
Emergency Medical Services.methods.statistics & numerical data
Middle Aged
Pulmonary Disease, Chronic Obstructive.diagnosis.therapy
Pulmonary Edema.diagnosis.therapy
Retrospective Studies
Urban Health Services.statistics & numerical data
Appears in Collections:Journal articles

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