Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, 1011, Lausanne, Switzerland.
Department of Emergency Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Scand J Trauma Resusc Emerg Med. 2021 Jun 29;29(1):85. doi: 10.1186/s13049-021-00900-7.
Noninvasive ventilation (NIV) is recognized as first line ventilatory support for the management of acute pulmonary edema (APE) and chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to study the prehospital management of patients in acute respiratory distress with an indication for NIV and whether they received it or not.
This retrospective study included patients ≥18 years old who were cared for acute respiratory distress in a prehospital setting. Indications for NIV were oxygen saturation (SpO) <90% and/or respiratory rate (RR) >25/min with a presumptive diagnosis of APE or COPD exacerbation. Study population characteristics, initial and at hospital vital signs, presumptive and definitive diagnosis were analyzed. For patients who received NIV, dyspnea level was evaluated with a dyspnea verbal ordinal scale (D-VOS, 0-10) and arterial blood gas (ABG) values were obtained at hospital arrival.
Among the 187 consecutive patients included in the study, most (n = 105, 56%) had experienced APE or COPD exacerbation, and 56 (30%) received NIV. In comparison with patients without NIV, those treated with NIV had a higher initial RR (35 ± 8/min vs 29 ± 10/min, p < 0.0001) and a lower SpO (79 ± 10 vs 88 ± 11, p < 0.0001). The level of dyspnea was significantly reduced for patients treated with NIV (on-scene D-VOS 8.4 ± 1.7 vs 4.4 ± 1.8 at admission, p < 0.0001). Among the 131 patients not treated with NIV, 41 (31%) had an indication. In the latter group, initial SpO was 80 ± 10% in the NIV group versus 86 ± 11% in the non-NIV group (p = 0.0006). NIV was interrupted in 9 (16%) patients due to either discomfort (n = 5), technical problem (n = 2), persistent desaturation (n = 1), or vomiting (n = 1).
The results of this study contribute to a better understanding of the prehospital management of patients who present with acute respiratory distress and an indication for NIV. NIV was started on clinically more severe patients, even if predefined criteria to start NIV were present. NIV allows to improve vital signs and D-VOS in those patients. A prospective study could further elucidate why patients with a suspected diagnosis of APE and COPD are not treated with NIV, as well as the clinical impact of the different strategies.
The study was approved by our institutional ethical committee ( CER-VD 2020-01363 ).
无创通气（NIV）被认为是急性肺水肿（APE）和慢性阻塞性肺疾病（COPD）加重患者管理的一线通气支持。我们旨在研究有 NIV 指征的急性呼吸窘迫患者的院前管理情况，以及他们是否接受了 NIV。
本回顾性研究纳入了在院前环境中接受急性呼吸窘迫治疗的≥18 岁患者。NIV 的指征为血氧饱和度（SpO₂）<90%和/或呼吸频率（RR）>25/min，伴有 APE 或 COPD 加重的推测诊断。分析了患者的初始和入院时生命体征、推测和明确诊断等特征。对于接受 NIV 的患者，使用呼吸困难口头排序量表（D-VOS，0-10）评估呼吸困难程度，并在入院时获得动脉血气（ABG）值。
在纳入的 187 例连续患者中，大多数（n=105，56%）患有 APE 或 COPD 加重，56 例（30%）接受了 NIV。与未接受 NIV 的患者相比，接受 NIV 的患者初始 RR 更高（35±8/min 比 29±10/min，p<0.0001），SpO₂更低（79±10%比 88±11%，p<0.0001）。接受 NIV 治疗的患者呼吸困难程度明显减轻（现场 D-VOS 为 8.4±1.7 分，入院时为 4.4±1.8 分，p<0.0001）。在未接受 NIV 治疗的 131 例患者中，41 例（31%）有 NIV 指征。在后者组中，NIV 组的初始 SpO₂为 80±10%，而非 NIV 组为 86±11%（p=0.0006）。由于不适（n=5）、技术问题（n=2）、持续低氧血症（n=1）或呕吐（n=1），有 9 例（16%）患者中断了 NIV。
本研究结果有助于更好地了解有 NIV 指征的急性呼吸窘迫患者的院前管理。NIV 开始于临床症状更严重的患者，即使存在开始 NIV 的既定标准。NIV 可改善这些患者的生命体征和 D-VOS。一项前瞻性研究可以进一步阐明为什么疑似 APE 和 COPD 的患者没有接受 NIV 治疗，以及不同策略的临床影响。
本研究得到了我们机构伦理委员会的批准（CER-VD 2020-01363）。
