Spijker Eva Eiske, de Bont Maarten, Bax Matthijs, Sandel Maro
Emergency Department, Haga Hospital, Leiden University, The Hague, The Netherlands.
Int J Emerg Med. 2013 Apr 8;6(1):8. doi: 10.1186/1865-1380-6-8.
Early use of continuous positive airway pressure (CPAP) has been shown to be beneficial within the setting of acute cardiogenic pulmonary edema (ACPE). The Boussignac CPAP system (BCPAP) was therefore introduced into the protocols of emergency medical services (EMS) in a large urban region. This study evaluates the implementation, practical use and complications of this prehospital treatment.
This was a retrospective case series study. The study was carried out in a period shortly after the implementation of the BCPAP system on all EMS ambulances in the The Hague region. According to protocol, diagnosis of ACPE in the prehospital setting was left to the discretion of the EMS paramedics and the facial mask was applied immediately after the diagnosis had been made. Patients were selected through hospital registration and diagnostic criteria for ACPE. Only those patients showing evident clinical signs of ACPE were included. Patient characteristics, physiologic variables, clinical outcomes and complications were collected from EMS transport reports and hospital records.
Between 1 June 2008 and 30 April 2009 a total of 180 patients were admitted for ACPE. Of these, 76 (42%) had evident clinical signs of ACPE upon presentation and were included. Three patients were transferred and in 14 cases data were missing. Out of the remaining 59 patients, 16 (27%) received BCPAP. In 43 (73%) cases the mask was not applied. For 7 out of 43 cases that were eligible for BCPAP treatment but did not receive the facial mask, an explanation was found in the EMS transport record. No complications were recorded pertaining to using the BCPAP system.
A significant portion of patients with clinical signs of acute cardiogenic pulmonary edema in the prehospital setting is not treated according to protocol using BCPAP. Based on the small group of patients that actually received BCPAP treatment, the facial mask seems feasible and effective for the treatment of acute cardiogenic pulmonary edema in the prehospital setting.
早期使用持续气道正压通气（CPAP）已被证明在急性心源性肺水肿（ACPE）的情况下是有益的。因此，布西尼亚克CPAP系统（BCPAP）被引入一个大城市地区的紧急医疗服务（EMS）协议中。本研究评估这种院前治疗的实施情况、实际使用情况和并发症。
这是一项回顾性病例系列研究。该研究在海牙地区所有EMS救护车实施BCPAP系统后不久进行。根据协议，院前环境中ACPE的诊断由EMS护理人员自行决定，诊断一经做出即立即应用面罩。通过医院登记和ACPE诊断标准选择患者。仅纳入那些表现出明显ACPE临床体征的患者。从EMS转运报告和医院记录中收集患者特征、生理变量、临床结局和并发症。
2008年6月1日至2009年4月30日期间，共有180例患者因ACPE入院。其中，76例（42%）就诊时具有明显的ACPE临床体征并被纳入研究。3例患者被转诊，14例数据缺失。在其余59例患者中，16例（27%）接受了BCPAP治疗。43例（73%）未应用面罩。在43例符合BCPAP治疗条件但未接受面罩治疗的病例中，有7例在EMS转运记录中找到了原因。未记录到与使用BCPAP系统相关的并发症。
院前环境中具有急性心源性肺水肿临床体征的患者中有很大一部分未按照使用BCPAP的协议进行治疗。基于实际接受BCPAP治疗患者的小样本，面罩似乎对院前环境中急性心源性肺水肿的治疗可行且有效。
