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Effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema.

机译：院前持续气道正压通气治疗急性肺水肿的有效性。

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Objective. To compare the effectiveness of continuous positive airway pressure (CPAP) with standard pharmacologic treatment in the management of prehospital acute pulmonary edema. Methods. Using a nonrandomized control group design, all consecutive patients presenting to two participating emergency medical services (EMS) systems with a field impression of acute pulmonary edema between July 1, 2004, and June 30, 2005, were included in the study. The control EMS system patients received standard treatment with oxygen, nitrates, furosemide, morphine, and, if indicated, endotracheal intubation. The intervention EMS system patients received CPAP via face mask at 10 cm H2O in addition to standard therapy. Results. Ninety-five patients received standard therapy, and 120 patients received CPAP and standard therapy. Intubation was required in 8.9% of CPAP-treated patients compared with 25.3% in the control group (p = 0.003), and mortality was lower in the CPAP group than in the control group (5.4% vs. 23.2%; p = 0.000). When compared with the control group, the CPAP group had more improvement in respiratory rate (-4.55 vs. -1.81; p = 0.001), pulse rate (-4.77 vs. 0.82; p = 0.013), and dyspnea score (-2.11 vs. -1.36; p = 0.008). Using logistic regression to control for potential confounders, patients receiving standard treatment were more likely to be intubated (odds ratio, 4.04; 95% confidence interval, 1.64 to 9.95) and more likely to die (odds ratio, 7.48; 95% confidence interval, 1.96 to 28.54) than those receiving standard therapy and CPAP. Conclusion. The prehospital use of CPAP is feasible, may avert the need for endotracheal intubation, and may reduce short-term mortality.
机译：目的。为了比较持续气道正压通气（CPAP）与标准药物治疗院前急性肺水肿的疗效。方法。使用非随机对照组的设计，研究纳入了2004年7月1日至2005年6月30日期间出现在两个参与紧急医疗服务（EMS）系统的所有患者的急性肺水肿的现场印象。对照EMS系统患者接受了氧气，硝酸盐，速尿，吗啡以及气管插管的标准治疗。干预EMS系统患者除标准治疗外，还通过10 cm H2O的面罩接受CPAP。结果。 95名患者接受了标准疗法，120名患者接受了CPAP和标准疗法。经CPAP治疗的患者需要进行插管操作的比例为8.9％，而对照组为25.3％（p = 0.003），并且CPAP组的死亡率低于对照组（5.4％vs. 23.2％; p = 0.000） 。与对照组相比，CPAP组的呼吸频率（-4.55比-1.81; p = 0.001），脉搏频率（-4.77比0.82; p = 0.013）和呼吸困难评分（-2.11vs。 --1.36; p ＝ 0.008）。使用Logistic回归控制潜在的混杂因素，接受标准治疗的患者更容易插管（赔率，4.04; 95％置信区间，1.64至9.95），更容易死亡（赔率，7.48; 95％置信区间，比接受标准疗法和CPAP的患者高1.96至28.54）。结论。院前使用CPAP是可行的，可以避免气管插管的需要，并可以降低短期死亡率。

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