Schmitt Felix C F, Gruneberg Daniel, Schneider Niko R E, Fögeling Jan-Ole, Leucht Moritz, Herth Felix, Preusch Michael R, Schmidt Werner, Bopp Christian, Bruckner Thomas, Weigand Markus A, Hofer Stefan, Popp Erik
Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany.
Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, 69126 Heidelberg, Germany.
J Clin Med. 2022 Apr 29;11(9):2504. doi: 10.3390/jcm11092504.
In this observational prospective multicenter study conducted between October 2016 and October 2018, we tested the hypothesis that the use of prehospital non-invasive ventilation (phNIV) to treat patients with acute respiratory insufficiency (ARI) caused by severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and acute cardiopulmonary oedema (ACPE) is effective, time-efficient and safe. The data were collected at four different physician response units and three admitting hospitals in a German EMS system. Patients with respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease and acute cardiopulmonary oedema were enrolled. A total of 545 patients were eligible for the final analysis. Patients were treated with oxygen supplementation, non-invasive ventilation or invasive mechanical ventilation. The primary outcomes were defined as changes in the clinical parameters and the in-hospital course. The secondary outcomes included time efficiency, peri-interventional complications, treatment failure rate, and side-effects. Oxygenation under phNIV improved equally to endotracheal intubation (ETI), and more effectively in comparison to standard oxygen therapy (SOT) (paO2 SOT vs. non-invasive ventilation (NIV) vs. ETI: 82 mmHg vs. 125 mmHg vs. 135 mmHg, p-value SOT vs. NIV < 0.0001). In a matched subgroup analysis phNIV was accompanied by a reduced time of mechanical ventilation (phNIV: 1.8 d vs. ETI: 4.2 d) and a shortened length of stay at the intensive care unit (3.4 d vs. 5.8 d). The data support the hypothesis that the treatment of severe AECOPD/ACPE-induced ARI using prehospital NIV is effective, time efficient and safe. Compared to ETI, a matched comparison supports the hypothesis that prehospital implementation of NIV may provide benefits for an in-hospital course.
在这项于2016年10月至2018年10月期间开展的前瞻性多中心观察性研究中，我们检验了以下假设：使用院前无创通气（phNIV）治疗由慢性阻塞性肺疾病严重急性加重（AECOPD）和急性心源性肺水肿（ACPE）引起的急性呼吸功能不全（ARI）患者是有效、省时且安全的。数据在德国急救医疗服务系统的四个不同医师响应单元和三家收治医院收集。纳入了因慢性阻塞性肺疾病急性加重和急性心源性肺水肿导致呼吸衰竭的患者。共有545例患者符合最终分析条件。患者接受了氧疗、无创通气或有创机械通气治疗。主要结局定义为临床参数的变化和住院病程。次要结局包括时间效率、围干预期并发症、治疗失败率和副作用。phNIV下的氧合改善程度与气管插管（ETI）相当，且与标准氧疗（SOT）相比更有效（SOT、无创通气（NIV）和ETI时的动脉血氧分压：82 mmHg对125 mmHg对135 mmHg，SOT与NIV比较的p值＜＜0.0001）。在一项匹配亚组分析中，phNIV伴随着机械通气时间缩短（phNIV：1.8天对ETI：4.2天）和重症监护病房住院时间缩短（3.4天对5.8天）。数据支持以下假设：使用院前NIV治疗严重AECOPD/ACPE诱发的ARI是有效、省时且安全的。与ETI相比，匹配比较支持以下假设：院前实施NIV可能对住院病程有益。
