von Düring Stephan, Chevalley Benjamin, Wozniak Hannah, Desmettre Thibaut, Quintard Hervé, Suppan Laurent, Fehlmann Christophe A
Division of Intensive Care Medicine, Department of Acute Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
BMC Emerg Med. 2025 Feb 27;25(1):32. doi: 10.1186/s12873-025-01193-0.
Non-invasive ventilation (NIV) is a cornerstone in the management of acute chronic obstructive pulmonary disease (COPD) exacerbations with respiratory failure. While extensively studied in hospital settings, limited data exist on its use in the pre-hospital setting and clinical factors influencing its application. This study aimed to identify predictors of NIV use in the pre-hospital setting and to assess its association with patient-centered outcomes.
This single-center retrospective cohort study analyzed data from a pre-hospital emergency medical service registry in Geneva, Switzerland. Adult patients with a presumptive diagnosis of acute COPD exacerbation were included, spanning a control period (2007-2010, before NIV implementation) and an intervention period (2013-2017, after NIV implementation). For the primary analysis, multivariable logistic regression was used to identify predictors of NIV use during the intervention period. For the secondary analysis, coarsened exact matching balanced patients treated with NIV during the intervention period with those from the control period, followed by conditional regression analyses to assess patient-centered outcomes.
Among 270 included patients, 84 (46%) received NIV during the intervention period. Age ≥ 70 years (aOR 2.49, 95% CI 1.11, 5.76), female sex (aOR 2.48, 95% CI 1.13, 5.60), and systolic blood pressure (SBP) ≥ 140 mmHg (aOR 2.75, 95% CI 1.19, 6.62) were independent predictors associated with receiving NIV in the pre-hospital setting. In the matched cohort, pre-hospital NIV use was significantly associated with increased ICU admission rates, but was not associated with transport time, emergency department length of stay, hospital length of stay, or 28-day mortality. Sensitivity analyses demonstrated consistent results across different modeling approaches.
Age ≥ 70 years, female sex, and SBP ≥ 140 mmHg were independent predictors associated with receiving NIV in the pre-hospital management of acute COPD exacerbation. The association between NIV use and increased ICU admissions may reflect its application in more severely ill patients. Pre-hospital NIV was not associated with short- or long-term outcomes beyond ICU admission. These findings underscore the need for prospective studies to clarify the role of pre-hospital NIV in patient outcomes.
无创通气（NIV）是治疗伴有呼吸衰竭的急性慢性阻塞性肺疾病（COPD）加重期的基石。虽然在医院环境中已得到广泛研究，但关于其在院前环境中的使用以及影响其应用的临床因素的数据有限。本研究旨在确定院前环境中使用NIV的预测因素，并评估其与以患者为中心的结局之间的关联。
这项单中心回顾性队列研究分析了瑞士日内瓦院前急救医疗服务登记处的数据。纳入了疑似急性COPD加重期的成年患者，涵盖一个对照期（2007 - 2010年，NIV实施前）和一个干预期（2013 - 2017年，NIV实施后）。对于主要分析，使用多变量逻辑回归来确定干预期内使用NIV的预测因素。对于次要分析，采用粗化精确匹配方法使干预期内接受NIV治疗的患者与对照期的患者达到平衡，随后进行条件回归分析以评估以患者为中心的结局。
在纳入的270例患者中，84例（46%）在干预期接受了NIV治疗。年龄≥70岁（调整后比值比[aOR] 2.49，95%置信区间[CI] 1.11，5.76）、女性（aOR 2.48，95% CI 1.13，5.60）和收缩压（SBP）≥140 mmHg（aOR 2.75，95% CI 1.19，6.62）是与院前接受NIV治疗相关的独立预测因素。在匹配队列中，院前使用NIV与入住重症监护病房（ICU）的比率增加显著相关，但与转运时间、急诊科住院时间、住院时间或28天死亡率无关。敏感性分析表明，不同建模方法的结果一致。
年龄≥70岁、女性和SBP≥140 mmHg是急性COPD加重期院前管理中接受NIV治疗的独立预测因素。使用NIV与ICU入院率增加之间的关联可能反映了其在病情更严重患者中的应用。院前NIV与ICU入院以外的短期或长期结局无关。这些发现强调需要进行前瞻性研究以阐明院前NIV在患者结局中的作用。
