Drkić Tatjana Jevtić, Šljivo Armin, Ljuhar Kenan, Tuco Amela Ahmić, Fetahović Lamija Hukić, Karamehić Emina, Ljuhar Amna Palikuća, Musić Jasna Husejinbegović, Jusufbegović Šejla Brković, Jusufbegović Edin, Terzić Salihbašić Selma, Bošnjak Melica Imamović, Blažević Riada, Valjevac Amina
Institute for Emergency Medical Assistance of Canton Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina.
Clinical Center of University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina.
Med Sci (Basel). 2025 Jan 1;13(1):5. doi: 10.3390/medsci13010005.
CPAP has been shown to be particularly beneficial in the management of acute cardiogenic pulmonary edema by reducing both preload and afterload, thus decreasing the work of breathing and improving oxygenation.
This study was a prospective observational study, conducted in the period from 2022 to 2024, assessing the effectiveness and safety of prehospital CPAP therapy use in patients with acute cardiogenic pulmonary edema, administered alongside standard care.
In this study, 50 patients with acute cardiogenic pulmonary edema were treated by physician-led emergency teams in the Canton of Sarajevo. CPAP significantly improved clinical parameters across all time points. Systolic blood pressure decreased from 151.0 ± 41.0 mmHg at initial contact to 138.4 ± 32.0 mmHg before transportation and further to 130.2 ± 28.5 mmHg upon hospital admission ( < 0.001). Diastolic pressure dropped from 85.6 ± 17.2 mmHg to 81.1 ± 15.2 mmHg before transportation ( = 0.018), with a slight further decrease to 80.2 ± 13.9 mmHg ( = 0.083). Heart rate fell from 114 ± 26.4 bpm to 111.3 ± 24.9 bpm before transportation ( = 0.003) and finally to 99.5 ± 18.2 bpm before hospital admission ( < 0.001). Respiratory rate decreased from 31.0 ± 10.2 to 28.0 ± 10.5 breaths/min ( = 0.002) and further to 22.6 ± 7.3 breaths/min ( < 0.001). End-tidal CO levels increased from 28.0 mmHg (23.5; 33.5) to 30.0 mmHg before transportation ( < 0.001), and to 35.0 mmHg (32.0; 37.5) before hospital admission ( < 0.001). Oxygen saturation improved from 79.0% (72.0; 81.0) to 84.0% before transportation ( < 0.001) and reached 94.0% (91.0; 98.2) before hospital admission ( < 0.001). VAS scores for dyspnea significantly dropped from 8.0 (6.0; 8.2) at initial contact to 6.0 (4.0; 8.0) before transportation ( < 0.001) and further to 4.0 (3.0; 5.0) before hospital admission ( < 0.001), indicating substantial symptom relief. ECG findings remained stable throughout the intervention.
Prehospital CPAP therapy significantly improved clinical outcomes in cardiogenic pulmonary edema, including reductions in blood pressure, heart rate, respiratory rate, and enhanced oxygenation and symptom relief. These findings support its broader use in emergency care, even during short transport times.
持续气道正压通气（CPAP）已被证明在急性心源性肺水肿的治疗中特别有益，它可同时降低前负荷和后负荷，从而减少呼吸功并改善氧合。
本研究为前瞻性观察性研究，于2022年至2024年期间进行，评估在标准治疗的同时，院前使用CPAP治疗急性心源性肺水肿患者的有效性和安全性。
在本研究中，萨拉热窝州由医生主导的急救团队对50例急性心源性肺水肿患者进行了治疗。CPAP在所有时间点均显著改善了临床参数。收缩压从初次接触时的151.0±41.0 mmHg降至转运前的138.4±32.0 mmHg，入院时进一步降至130.2±28.5 mmHg（P<0.001）。舒张压从85.6±17.2 mmHg降至转运前的81.1±15.2 mmHg（P = 0.018），入院前略有进一步下降至80.2±13.9 mmHg（P = 0.083）。心率从114±26.4次/分钟降至转运前的111.3±24.9次/分钟（P = 0.003），入院前最终降至99.5±18.2次/分钟（P<0.001）。呼吸频率从31.0±10.2次/分钟降至28.0±10.5次/分钟（P = 0.002），进一步降至22.6±7.3次/分钟（P<0.001）。呼气末二氧化碳水平从28.0 mmHg（23.5；33.5）升至转运前的30.0 mmHg（P<0.001），入院前升至35.0 mmHg（32.0；37.5）（P<0.001）。氧饱和度从79.0%（72.0；81.0）升至转运前的84.0%（P<0.001），入院前达到94.0%（91.0；98.2）（P<0.001）。呼吸困难的视觉模拟评分（VAS）从初次接触时的8.0（6.0；8.2）显著降至转运前的6.0（4.0；8.0）（P<0.001），入院前进一步降至4.0（3.0；5.0）（P<0.001），表明症状明显缓解。整个干预过程中心电图结果保持稳定。
院前CPAP治疗显著改善了心源性肺水肿的临床结局，包括血压、心率、呼吸频率降低，以及氧合改善和症状缓解。这些发现支持其在急诊护理中更广泛的应用，即使在短距离转运期间。
