Hubble Michael W, Richards Michael E, Jarvis Roger, Millikan Tori, Young Dwayne
Emergency Medical Care Program, Western Carolina University, Cullowhee, NC 28723, USA.
Prehosp Emerg Care. 2006 Oct-Dec;10(4):430-9. doi: 10.1080/10903120600884848.
To compare the effectiveness of continuous positive airway pressure (CPAP) with standard pharmacologic treatment in the management of prehospital acute pulmonary edema.
Using a nonrandomized control group design, all consecutive patients presenting to two participating emergency medical services (EMS) systems with a field impression of acute pulmonary edema between July 1, 2004, and June 30, 2005, were included in the study. The control EMS system patients received standard treatment with oxygen, nitrates, furosemide, morphine, and, if indicated, endotracheal intubation. The intervention EMS system patients received CPAP via face mask at 10 cm H2O in addition to standard therapy.
Ninety-five patients received standard therapy, and 120 patients received CPAP and standard therapy. Intubation was required in 8.9% of CPAP-treated patients compared with 25.3% in the control group (p = 0.003), and mortality was lower in the CPAP group than in the control group (5.4% vs. 23.2%; p = 0.000). When compared with the control group, the CPAP group had more improvement in respiratory rate (-4.55 vs. -1.81; p = 0.001), pulse rate (-4.77 vs. 0.82; p = 0.013), and dyspnea score (-2.11 vs. -1.36; p = 0.008). Using logistic regression to control for potential confounders, patients receiving standard treatment were more likely to be intubated (odds ratio, 4.04; 95% confidence interval, 1.64 to 9.95) and more likely to die (odds ratio, 7.48; 95% confidence interval, 1.96 to 28.54) than those receiving standard therapy and CPAP.
The prehospital use of CPAP is feasible, may avert the need for endotracheal intubation, and may reduce short-term mortality.
比较持续气道正压通气（CPAP）与标准药物治疗在院前急性肺水肿管理中的效果。
采用非随机对照组设计，纳入2004年7月1日至2005年6月30日期间连续就诊于两个参与研究的急救医疗服务（EMS）系统、现场诊断为急性肺水肿的所有患者。对照组EMS系统的患者接受氧气、硝酸盐、呋塞米、吗啡等标准治疗，必要时进行气管插管。干预组EMS系统的患者除接受标准治疗外，还通过面罩以10 cm H₂O的压力接受CPAP治疗。
95例患者接受标准治疗，120例患者接受CPAP及标准治疗。CPAP治疗组患者气管插管率为8.9%，而对照组为25.3%（p = 0.003），CPAP组的死亡率低于对照组（5.4%对23.2%；p = 0.000）。与对照组相比，CPAP组患者的呼吸频率改善更明显（-4.55对-1.81；p = 0.001）、脉搏率改善更明显（-4.77对0.82；p = 0.013）、呼吸困难评分改善更明显（-2.11对-1.36；p = 0.008）。通过逻辑回归控制潜在混杂因素后，接受标准治疗的患者比接受标准治疗加CPAP的患者更有可能接受气管插管（优势比，4.04；95%置信区间，1.64至9.95），且更有可能死亡（优势比，7.48；95%置信区间，1.96至28.54）。
院前使用CPAP是可行的，可能避免气管插管的需要，并可能降低短期死亡率。
