Low–Fractional Oxygen Concentration Continuous Positive Airway Pressure is Effective in the Prehospital Setting

Bledsoe, Bryan E; Anderson, Eric; Hodnick, Ryan; Johnson, Larry; Johnson, S.; Dievendorf, Eric

doi:10.3109/10903127.2011.640765

Cited by 18 publications

(18 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although four studies 61,70,71,79 did not provide details relating to the CPAP interface, six studies used a face mask 62,68,73,75,76,78 and one used a helmet 69 as the interface of choice for the administration of CPAP. NIV was administered by paramedics in two studies, 62,76 physicians in four studies, 71,73,75,78 an ambulance nurse in one study, 68 a physician or nurse in one study, 69 and an emergency service team in one study. 79 Three studies 61,63,70 provided no information on the category of medical personnel that administered pre-hospital NIV.…”

mentioning

confidence: 99%

“…Studies were published between 2000 and 2013, and were undertaken in Finland, 75 France, 61,63,78 Greece, 71,73 Italy, 69 the Netherlands, 68 Portugal, 70 and the USA. 62,76,79 Two studies 61,75 collected data retrospectively, while the remaining studies used a prospective study design. 62,63,[68][69][70][71]73,76,78,79 While all studies included patients with acute respiratory distress, there was wide variation in terms of underlying conditions resulting in respiratory failure.…”

mentioning

confidence: 99%

“…62,76,79 Two studies 61,75 collected data retrospectively, while the remaining studies used a prospective study design. 62,63,[68][69][70][71]73,76,78,79 While all studies included patients with acute respiratory distress, there was wide variation in terms of underlying conditions resulting in respiratory failure. The sample sizes of the studies ranged between 19 patients 76 to 340 patients, 62 with the mean age of participants ranging from 67.7 years 62 to 78.3 years 69 (no details of mean age were provided in four studies).…”

mentioning

confidence: 99%

“…Non-randomised observational studies without a control group Twelve studies [61][62][63][68][69][70][71]73,75,76,78,79 described the use of pre-hospital NIV in patients with acute respiratory failure. A summary of the studies is presented in Table 14.…”

mentioning

confidence: 99%

“…62,63,[68][69][70][71]73,76,78,79 While all studies included patients with acute respiratory distress, there was wide variation in terms of underlying conditions resulting in respiratory failure. The sample sizes of the studies ranged between 19 patients 76 to 340 patients, 62 with the mean age of participants ranging from 67.7 years 62 to 78.3 years 69 (no details of mean age were provided in four studies). 68,73,75,79 , In one study, 61 the mean age of patients was reported separately by underlying condition (asthma, 48 years and COPD, 68 years)…”

mentioning

confidence: 99%

See 4 more Smart Citations

Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation

Pandor

Thokala

Goodacre

et al. 2015

Health Technol Assess

View full text Add to dashboard Cite

BackgroundNon-invasive ventilation (NIV), in the form of continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP), is used in hospital to treat patients with acute respiratory failure. Pre-hospital NIV may be more effective than in-hospital NIV but requires additional ambulance service resources.ObjectivesWe aimed to determine the clinical effectiveness and cost-effectiveness of pre-hospital NIV compared with usual care for adults presenting to the emergency services with acute respiratory failure and to identify priorities for future research.Data sourcesFourteen electronic databases and research registers (including MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature) were searched from inception to August 2013, supplemented by hand-searching reference lists and contacting experts in the field.Review methodsWe included all randomised or quasi-randomised controlled trials of pre-hospital NIV in patients with acute respiratory failure. Methodological quality was assessed according to established criteria. An aggregate data network meta-analysis (NMA) of mortality and intubation was used to jointly estimate intervention effects relative to usual care. A NMA, using individual patient-level data (IPD) and aggregate data where IPD were not available, was carried out to assess whether or not covariates were treatment effect modifiers. A de novo economic model was developed to explore the costs and health outcomes when pre-hospital NIV (specifically CPAP provided by paramedics) and standard care (in-hospital NIV) were applied to a hypothetical cohort of patients with acute respiratory failure.ResultsThe literature searches identified 2284 citations. Of the 10 studies that met the inclusion criteria, eight were randomised controlled trials and two were quasi-randomised trials (six CPAP; four BiPAP; sample sizes 23–207 participants). IPD were available from seven trials (650 patients). The aggregate data NMA 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 with 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) compared with standard care was uncertain. The combined IPD and aggregate data NMA suggested that sex was a statistically significant treatment effect modifier for mortality. The economic analysis showed that pre-hospital CPAP was more effective and more expensive than standard care, with an incremental cost-effectiveness ratio of £20,514 per quality-adjusted life-year (QALY) and a 49.5% probability of being cost-effective at the £20,000-per-QALY threshold. Variation in the incidence of eligible patients had a marked impact on cost-effectiveness and the expected value of sample information for a future randomised trial.LimitationsThe meta-analysis lacked power to detect potentially important differences in outcome (particularly for BiPAP), the intervention was not always compared with the best alternative care (in-hospital NIV) in the primary studies and findings may not be generalisable.ConclusionsPre-hospital CPAP can reduce mortality and intubation rates, but cost-effectiveness is uncertain and the value of further randomised evaluation depends on the incidence of suitable patients. A feasibility study is required to determine if a large pragmatic trial of clinical effectiveness and cost-effectiveness is appropriate.Study registrationThe study is registered as PROSPERO CRD42012002933.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract