Out of hospital non-invasive ventilation in adults with acute respiratory failure
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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.