Abstract:
Introduction: Noninvasive ventilation (NIV) is commonly used in the inhospital
treatment of acute respiratory failure. Studies have demonstrated that the use of NIV in
acute respiratory failure reduces intubation rates, mortality as well as improves
physiologic variables such as heart rate, respiratory rate, oxygen saturation and blood
pressure.
Objective: This systematic review attempts to determine if the addition of prehospital
NIV/CPAP to standard care reduces the rate of endotracheal intubation compared to
standard care alone.
Methods: A systematic review was conducted in January 2016 using, PubMed,
EMBASE and Scopus. Included studies were those that compared the addition of
prehospital NIV/CPAP to standard care versus standard care alone in patients with acute
respiratory failure. Randomized controlled trials, retrospective studies as well as before
and after studies were included.
Results: Five studies met the inclusion criteria. Two randomized controlled trials, two
retrospective studies and one before and after study. Three studies reported a decrease in
the intubation rate, one specifically when CPAP was continued in the emergency
department. Two studies reported an improvement in physiologic variables in the groups
treated with CPAP. One study reported a shorter intensive care unit length of stay, and
one study reported a decrease in mortality in the CPAP group.
Conclusion: Prehospital NIV/CPAP is an effective and safe treatment for patients with
acute respiratory failure. The administration of prehospital NIV can reduce rates of
endotracheal intubation and improve overall physiologic variables. However larger randomized controlled trials are required to determine the implementation of prehospital
CPAP in acute respiratory failure EMS protocols.
