Weitz Gunther, Struck Jan, Zonak Andrea, Balnus Sven, Perras Boris, Dodt Christoph
Department of Internal Medicine I, Conservative Intensive Care and Emergency Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
Eur J Emerg Med. 2007 Oct;14(5):276-9. doi: 10.1097/MEJ.0b013e32826fb377.
Severe acute cardiogenic pulmonary edema (ACPE) can successfully be treated with noninvasive pressure support ventilation (NIPSV) in a clinical setting. Whether prehospital NIPSV starting early at patients' home and being continued until hospital arrival is feasible and improves ACPE emergency care is examined in this study. End points of the study were oxygen saturation at hospital admission and clinical outcome. Twenty-three patients suffering from severe cardiac pulmonary edema with severe dyspnea, an oxygen saturation of less than 90% and basal rales were included in this controlled prospective randomized trial. All patients received standard medical treatment and 10 patients were additionally treated with NIPSV (pressure support level, 12 cmH2O; positive endexpiratory pressure, 5 cmH2O; FiO2, 0.6) whereas the other patients received oxygen (8 l/min) via Venturi face mask. Improvement in oxygen saturation was significantly faster in the NIPSV group and oxygen saturation was higher at the time of the hospital admission (NIPSV=97.3+/-0.8%; standard=89.5+/-2.7%, P=0.002). A trend toward higher troponin T levels was seen in the standard treatment group. The need for intensive care treatment did not differ, and one patient of each treatment group died in hospital. No complications were noted during the treatment with NIPSV. Prehospital NIPSV is feasible and able to improve emergency management of ACPE.
在临床环境中，无创压力支持通气（NIPSV）可成功治疗严重急性心源性肺水肿（ACPE）。本研究探讨了在患者家中早期启动并持续至入院的院前NIPSV是否可行以及是否能改善ACPE的急诊护理。研究的终点是入院时的血氧饱和度和临床结局。23例患有严重心源性肺水肿、严重呼吸困难、血氧饱和度低于90%且有基底啰音的患者纳入了这项对照前瞻性随机试验。所有患者均接受标准药物治疗，10例患者额外接受NIPSV治疗（压力支持水平为12 cmH₂O；呼气末正压为5 cmH₂O；吸入氧浓度为0.6），而其他患者通过文丘里面罩接受氧气（8 l/min）治疗。NIPSV组的血氧饱和度改善明显更快，且入院时血氧饱和度更高（NIPSV组=97.3±0.8%；标准治疗组=89.5±2.7%，P=0.002）。标准治疗组肌钙蛋白T水平有升高趋势。重症监护治疗的需求没有差异，每个治疗组各有1例患者在医院死亡。NIPSV治疗期间未观察到并发症。院前NIPSV是可行的，并且能够改善ACPE的急诊管理。
