Effect of Out-of-Hospital Noninvasive Positive-Pressure Support Ventilation in Adult Patients With Severe Respiratory Distress: A Systematic Review and Meta-analysis

Mal, Sameer; McLeod, Shelley; Iansavichene, Alla; Dukelow, A.; Lewell, Michael

doi:10.1016/j.annemergmed.2013.11.013

Cited by 44 publications

(38 citation statements)

References 27 publications

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“…2,9 In a recent systematic review of randomized control trials by Mal et al, a significant reduction in mortality and need for invasive ventilation both in and out of the hospital was found. 13 Williams et al came to the same conclusion in their meta-analysis that included non-randomized and observational studies.…”

Section: Discussionmentioning

confidence: 68%

Effectiveness and safety of a prehospital program of continuous positive airway pressure (CPAP) in an urban setting

Willmore

Dionne

Maloney

et al. 2015

CJEM

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Background: Continuous positive airway pressure (CPAP) is commonly used in the treatment of acute cardiogenic pulmonary edema (ACPE) and acute exacerbations of chronic obstructive pulmonary disease (AECOPD). In-hospital evidence is robust: CPAP has been shown to improve respiratory status and to reduce intubation rates. There is less evidence on prehospital CPAP, although the emergency medical services (EMS) adoption of this modality is increasing. The objectives of this study were to 1) measure the effectiveness of prehospital CPAP on morbidity, mortality, and transport times; and 2) audit the selection of patients by medics for appropriateness and safety. Methods: We conducted a before-and-after study from August 1 to October 31 in 2010 and 2011, before and after the implementation of prehospital CPAP in a city of one million people with large rural areas. Medics were trained to apply CPAP to patients with respiratory distress and a presumed diagnosis of ACPE or AECOPD. Charts were selected using the search criteria of the chief complaint of shortness of breath, emergent transport to hospital, and any patients receiving CPAP in the field. Data extracted from ambulance call reports and hospital records were analysed with appropriate univariate statistics. Results: A total of 373 patients enrolled (186 pre-non-invasive ventilation [NIV] and 187 post-NIV), mean age 71.5 years, female 51.4%, and final diagnoses of ACPE 18.9%, AECOPD 21.9%. In the post group of 84 patients meeting NIV criteria, 41.6% received NIV; and of 102 patients not meeting the criteria, 5.2% received NIV. There were 12 minor adverse events in 36 applications (33.3%) as per protocol. Comparing post versus pre, there were higher rates of emergency department (ED) NIV (20.0% v. 13.4%, p < 0.0001) and higher overall mortality (18.8% v. 14.9%, p < 0.0001). There were no differences in ED intubation (2.1% v. 2.3%, p < 0.001) and length of stay (6.8 v. 8.7 days, p = 0.24). Conclusion: Despite the robust in-hospital data supporting its use, we could not find benefit from CPAP in our prehospital

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Section: Discussionmentioning

confidence: 68%

Effectiveness and safety of a prehospital program of continuous positive airway pressure (CPAP) in an urban setting

Willmore

Dionne

Maloney

et al. 2015

CJEM

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“…13,14 Williams et al 13 only evaluated prehospital CPAP and included nonrandomized studies. They reported that CPAP was associated with lower mortality and fewer intubations, with similar ORs to ours.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 These suggest that prehospital NIV, and specifically prehospital CPAP, can improve outcomes. Existing systematic reviews have been limited by failure to undertake meta-analyses, [10][11][12] inclusion of nonrandomized studies in the meta-analyses, 13 failure to include studies only published in abstract form, 14 analysis of CPAP and BiPAP together, 14 lack of a network meta-analysis to compare CPAP and BiPAP, 13,14 and lack of individual patient data meta-regression to explore potential causes of heterogeneity.…”

mentioning

confidence: 99%

“…Existing systematic reviews have been limited by failure to undertake meta-analyses, [10][11][12] inclusion of nonrandomized studies in the meta-analyses, 13 failure to include studies only published in abstract form, 14 analysis of CPAP and BiPAP together, 14 lack of a network meta-analysis to compare CPAP and BiPAP, 13,14 and lack of individual patient data meta-regression to explore potential causes of heterogeneity. 13,14 We aimed to address these limitations by undertaking a systematic review, aggregate data network meta-analysis, and individual patient data meta-analysis of randomized and quasi-randomized controlled trials to determine the effect of prehospital CPAP and BiPAP on mortality (primary outcome) and endotracheal intubation (secondary outcome), in patients with acute respiratory failure.…”

mentioning

confidence: 99%

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Prehospital Noninvasive Ventilation for Acute Respiratory Failure: Systematic Review, Network Meta‐analysis, and Individual Patient Data Meta‐analysis

Goodacre

Stevens

Pandor

et al. 2014

Academic Emergency Medicine

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Objectives: This meta-analysis aimed to determine the effectiveness of prehospital continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP) in acute respiratory failure.Methods: Fourteen electronic databases and research registers were searched from inception to August 2013. Randomized or quasi-randomized controlled trials that reported mortality or intubation rate for prehospital CPAP or BiPAP were selected and compared to a relevant comparator in patients with acute respiratory failure. An aggregate data network meta-analysis was used to jointly estimate intervention effects relative to standard care. A network meta-analysis using a mixture of individual patient-level data and aggregate data was carried out to assess potential treatment effect modifiers.Results: Eight randomized and two quasi-randomized controlled trials (six CPAP, four BiPAP, sample sizes 23 to 207) were identified. The aggregate data network meta-analysis suggested that CPAP was the most effective treatment in terms of mortality (probability = 0.989) and intubation rate (probability = 0.639) and reduced both mortality (odds ratio [OR] = 0.41; 95% credible interval [CrI] = 0.20 to 0.77) and intubation rate (OR = 0.32; 95% CrI = 0.17 to 0.62), compared to standard care. The effect of BiPAP on mortality (OR = 1.94; 95% CrI = 0.65 to 6.14) and intubation rate (OR = 0.40; 95% CrI = 0.14 to 1.16) was uncertain. The network meta-analysis using individual patient-level data and aggregate data suggested that sex was a modifier of the effect of treatment on mortality. A cute respiratory failure is a common but lifethreatening medical emergency, especially in elderly patients with respiratory and cardiac diseases. [1][2][3] It is caused by a number of common cardiac or respiratory conditions, including heart failure, pneumonia, and exacerbation of chronic obstructive pulmonary disease. The definitive treatment of acute respiratory failure depends on the underlying cause, but patients often require prehospital treatment. At this point it is difficult to accurately determine the underlying cause, so prehospital treatment of acute respiratory failure often follows a common pathway, rather than being specific to the underlying cause. ConclusionsNoninvasive ventilation (NIV) can be used to treat acute respiratory failure. [4][5][6] It involves providing respiratory support through a tight-fitting mask that is usually applied around the patient's mouth and nose and may take the form of continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP), including noninvasive pressure support ventilation. It is normally used in the hospital, but it may be more effective if treatment is commenced prior to arrival.7 Prehospital NIV is considered in some guidelines, 8,9 but widespread use is limited by the need for additional training and equipment and may be informed by robust evidence of clinical effectiveness and cost-effectiveness.Prehospital NIV has been evaluated in a number o...

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“…Prehospital early use of NIMV in adults and children in many cases avoids complications, decreases the need for invasive mechanical ventilation (IMV), and shortens the time to symptom control, reducing risks and allowing safer transfers. 2,8,9 The use of noninvasive positive-pressure ventilation in the air medical environment has been minimally researched to date. 10,11 In this study, we attempt to show the feasibility, safety, and some of the advantages of NIMV over SMT in helicopter emergency medical services (HEMS).…”

Section: Noninvasive Mechanical Ventilation In Helicopter Emergency Mmentioning

confidence: 99%

Noninvasive Mechanical Ventilation in Helicopter Emergency Medical Services Saves Time and Oxygen and Improves Patient and Mission Safety: A Pilot Study

Garrote¹,

Aylagas²,

Gutiérrez³

et al. 2015

Air Medical Journal

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Effect of Out-of-Hospital Noninvasive Positive-Pressure Support Ventilation in Adult Patients With Severe Respiratory Distress: A Systematic Review and Meta-analysis

Cited by 44 publications

References 27 publications

Effectiveness and safety of a prehospital program of continuous positive airway pressure (CPAP) in an urban setting

Effectiveness and safety of a prehospital program of continuous positive airway pressure (CPAP) in an urban setting

Prehospital Noninvasive Ventilation for Acute Respiratory Failure: Systematic Review, Network Meta‐analysis, and Individual Patient Data Meta‐analysis

Noninvasive Mechanical Ventilation in Helicopter Emergency Medical Services Saves Time and Oxygen and Improves Patient and Mission Safety: A Pilot Study

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