Craven R A, Singletary N, Bosken L, Sewell E, Payne M, Lipsey R
East Coast Clinical Research, LLC, Virginia Beach, VA, USA.
Acad Emerg Med. 2000 Sep;7(9):1065-8. doi: 10.1111/j.1553-2712.2000.tb02102.x.
To evaluate the utility of bilevel positive airway pressure (BiPAP) in the out-of-hospital treatment of patients with presumed congestive heart failure (CHF).
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.
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.
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.
评估双水平气道正压通气（BiPAP）在疑似充血性心力衰竭（CHF）患者院外治疗中的效用。
这是一项前瞻性、序贯、平行试验，于1999年1月4日至4月15日在由单一紧急医疗服务（EMS）系统服务的城市环境中进行。纳入了由接受高级生命支持培训的急救医疗技术人员（ALS急救医疗技术人员）判断为CHF并由救援单位转运的成年便利样本。救援小组被分为人口统计学匹配的对子，每个对子中的一个配备了BiPAP通气支持设备。双水平气道正压通气治疗被添加到符合条件的研究患者的现有治疗方案中。主要结局指标为院外治疗时间、血氧饱和度变化、住院时间、气管插管需求、死亡率以及EMS人员使用该设备的便捷程度。
71名入组患者中有62名完成了研究。两组的院外治疗时间无差异（31.2分钟对31.4分钟；p = 0.931）。BiPAP组治疗前后血氧饱和度水平的差异（13.71%）大于对照组（6.69%）（p < 0.05）。两组在住院时间[对照组：7.63天，BiPAP组：6.33天，p = 0.48]、插管率[对照组：25例中有7例（28%），BiPAP组：37例中有4例（11%），p = 0.10]或死亡率[对照组：24例中有2例，BiPAP组：37例中有6例，p = 0.46]方面无统计学差异。所有使用BiPAP的ALS急救医疗技术人员都认为使用该设备是安全的，97%的人认为使用方便，且似乎能改善患者的呼吸困难和呼吸窘迫。
可以培训ALS急救医疗技术人员使用BiPAP进行无创通气，他们发现其易于应用，并认为它有助于缓解疑似CHF患者的呼吸困难。
