Garuti G, Bandiera G, Cattaruzza M S, Gelati L, Osborn J F, Toscani S, Confalonieri M, Lusuardi M
Pulmonary Rehabilitation Unit, AUSL of Reggio Emilia, S. Sebastiano Hospital, Correggio (RE), Italy.
Monaldi Arch Chest Dis. 2010 Dec;73(4):145-51. doi: 10.4081/monaldi.2010.283.
Acute respiratory failure (ARF) is a condition that must be treated as quickly as possible. Continuous Positive Airway Pressure (CPAP) is a common method used to treat ARF in hospital. The main objective of our study was to investigate the effect of CPAP prior to admission to the emergency room, on the reduction of endotracheal intubation, in-hospital mortality and on the length of stay in hospital (HLOS).
A prospective, observational (non-randomised) study with a historical control group. Data from 3 groups of patients with ARF, irrespective of cause, was collected: pre-hospital CPAP (PHCPAP) group, i.e., 35 patients treated with a helmet CPAP in the ambulance, by trained nurses (mean age, years 80.1 +/- 7.9 SD; 14 males); hospital CPAP (HCPAP) group, i.e., 46 patients treated with helmet CPAP in the hospital emergency room (mean age 78.6 +/- 6.9 SD; 27 males), and a historical control group of 125 patients treated with medical therapy only (mean age 76.7 +/- 5.5 SD; 52 males). CPAP was delivered via a helmet interface.
Compared with standard medical therapy, helmet CPAP (pre and in-hospital) reduced mortality by 77% (p = 0.005), while pre-hospital helmet CPAP reduced it by 94% (p = 0.011), after adjustment for age, sex, severity of clinical conditions at entry and diagnosis upon admission. HLOS was reduced, compared with standard medical therapy, by 63.5% and by 66% (adjusting for age, sex, severity of clinical conditions at entry and diagnosis at admission) with helmet CPAP (pre and in-hospital) and with helmet CPAP in the ambulance, respectively (p < 0.0001).
Treating patients with ARF of any cause, with CPAP by trained nurses, before hospital admission, is safe, reduces mortality and the length of stay needed in hospital.
急性呼吸衰竭（ARF）是一种必须尽快治疗的病症。持续气道正压通气（CPAP）是医院治疗ARF常用的方法。我们研究的主要目的是调查在进入急诊室之前使用CPAP对减少气管插管、降低院内死亡率以及缩短住院时间（HLOS）的效果。
一项设有历史对照组的前瞻性观察性（非随机）研究。收集了3组ARF患者的数据，不论病因如何：院前CPAP（PHCPAP）组，即35例在救护车上由经过培训的护士使用头盔式CPAP进行治疗的患者（平均年龄80.1±7.9岁标准差；14例男性）；院内CPAP（HCPAP）组，即46例在医院急诊室使用头盔式CPAP进行治疗的患者（平均年龄78.6±6.9岁标准差；27例男性），以及一个仅接受药物治疗的125例患者的历史对照组（平均年龄76.7±5.5岁标准差；52例男性）。CPAP通过头盔接口输送。
与标准药物治疗相比，（院前和院内）头盔式CPAP使死亡率降低了77%（p = 0.005），而院前头盔式CPAP在对年龄、性别、入院时临床病情严重程度和入院诊断进行调整后，使死亡率降低了94%（p = 0.011）。与标准药物治疗相比，（院前和院内）头盔式CPAP以及救护车上的头盔式CPAP分别使住院时间缩短了63.5%和66%（对年龄、性别、入院时临床病情严重程度和入院诊断进行调整后）（p < 0.0001）。
在院前由经过培训的护士使用CPAP治疗任何病因的ARF患者是安全的，可降低死亡率和住院所需时间。
