Effect of noninvasive ventilation on intubation risk in prehospital patients with acute cardiogenic pulmonary edema: a retrospective study

Abstract

Objective The aim of this study was to assess the effect of prehospital noninvasive ventilation for acute cardiogenic pulmonary edema on endotracheal intubation rate and on ICU admission rate. Methods We carried out a retrospective study on patients’ prehospital files between 2007 and 2010 (control period), and between 2013 and 2016 (intervention period). Adult patients were included if a diagnosis of acute cardiogenic pulmonary edema was made by the prehospital physician. Exclusion criteria were a Glasgow coma scale score less than 9 or any other respiratory diagnosis. We analyzed the association between noninvasive ventilation implementation and endotracheal intubation or ICU admission with univariable and multivariable regression models. The primary outcome was prehospital endotracheal intubation rate. Secondary outcomes were admission to an ICU, prehospital intervention length, and 30-day mortality. Results A total of 1491 patients were included. Noninvasive ventilation availability was associated with a significant decrease in endotracheal intubation rate (2.6% in the control versus 0.7% in the intervention period), with an adjusted odds ratio (OR) of 0.3 [95% confidence interval (CI), 0.1–0.7]. There was a decrease in ICU admissions (18.6% in the control versus 13.0% in the intervention period) with an adjusted OR of 0.6 (95% CI, 0.5–0.9). There was no significant change in 30-day mortality (11.2% in the control versus 11.0% in the intervention period, P = 0.901). Conclusion In our physician-staffed prehospital system, use of noninvasive ventilation for acute cardiogenic pulmonary edema decreased both endotracheal intubation and ICU admission rates.

Prehospital reversal of profound respiratory acidosis and hypercapnic coma by non-invasive ventilation: a report of two cases

“…As a physician-staffed emergency mobile unit assists regular ambulances in case of life-threatening emergencies such as ARF in our prehospital system, critical patients are constantly monitored by an emergency physician throughout transport [10]. In a system allowing well trained healthcare providers to immediately react by withdrawing the NIV mask, tilting the patient on the side, suctioning the airways, or even performing immediate rapid-sequence intubation, we believe that NIV can be considered even in situations where ETI is still often considered as a first choice.…”

“…In Geneva, an emergency mobile unit called "Service Mobile d'Urgence et de Réanimation" (SMUR), staffed by an advanced paramedic and a physician, can be dispatched to assist a regular ambulance in case of lifethreatening emergencies [10]. All SMUR vehicles have been equipped by a Hamilton T1 ventilator (Hamilton Medical, Bonaduz, Switzerland) since 2013, and the decision to initiate NIV is made by the physician according to his clinical evaluation.…”

Endotracheal Intubation Success Rate in an Urban, Supervised, Resident-Staffed Emergency Mobile System: An 11-Year Retrospective Cohort Study

“…In the prehospital setting, endotracheal intubation (ETI) is often required to secure the patient's airways [1]. An ETI is indicated in various conditions, including cardiac arrest (CA) [2][3][4][5][6], respiratory distress refractory to standard treatment [7,8], coma and traumatic injuries [9,10].…”

Association between Prehospital Arterial Hypercapnia in Acute Heart Failure and Admission to Acute Care Units: a Retrospective Cohort Study

“…This study was realized in the prehospital medical unit (called SMUR for Service Mobile d'Urgence et de Réanimation) of the Geneva University Hospitals in Switzerland, the detailed organization of which has previously been described [12]. Brie y, the prehospital emergency medical response in Geneva consists of three levels of increasing expertise (advanced life support ambulance, medical mobile unit, senior emergency-medicine certi ed physician).…”

“…Classical treatment includes use of vasodilators, diuretics and oxygen, as well as positive end-expiratory pressure (PEEP), with or without pressure support (PS), for severe AHF [3][4][5][6][7][8][9][10][11]. In the prehospital setting, application of PEEP, whether by use of continuous positive airway pressure (CPAP) or of noninvasive ventilation (NIV), is associated with an improvement of vital parameters and a reduction in both endotracheal intubation (ETI) and intensive care unit (ICU) admission rates [12][13][14][15][16]. Common negative prognostic markers for AHF include hypotension on admission, advanced age and polymorbidity, as well as an ischemic etiology [2].…”