|Year : 2017 | Volume
| Issue : 1 | Page : 47-48
Noninvasive ventilation: Is a prehospital initiation an option?
Mohammed D AlAhmari
Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dhahran, Dammam 31448, Kingdom of Saudi Arabia
|Date of Web Publication||23-Jun-2017|
Mohammed D AlAhmari
Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dhahran, P.O. Box 33048, Dammam 31448
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Non-invasive ventilation (NIV) refers to the use of ventilator support by delivering a pressurized gas via external facial interfaces. NIV is commonly used by clinicians to avoid intubation and the risks associated with invasive positive mechanical ventilation. NIV has recently become an integral tool in the management of acute conditions and chronic respiratory failure. This therapeutic modality is well recognized in selected patients with acute respiratory failure (ARF) related to exacerbation of chronic obstructive pulmonary disease, acute cardiogenic pulmonary edem and immunocompromised states. Several studies have shown that NIV play a crucial role in reducing the need for endotracheal intubation, length of hospitalization, morbidity and mortality. It is also used as a prophylactic interventional tool in post-extubation patients to prevent re-intubation cases. A patient at high risk of re-intubation may benefit from NIV application; however, close monitoring is essential to detect any indicative signs of extubation failure.
Keywords: Non-invasive ventilation, NIV, pre-hospital initiation
|How to cite this article:|
AlAhmari MD. Noninvasive ventilation: Is a prehospital initiation an option?. Saudi Crit Care J 2017;1:47-8
Noninvasive ventilation (NIV) refers to the use of ventilatory support by delivering a pressurized gas through external facial interfaces. NIV is commonly used by clinicians to avoid intubation and the risks associated with invasive positive mechanical ventilation. NIV has recently become an integral tool in the management of acute conditions and chronic respiratory failure. This therapeutic modality is well recognized in selected patients with acute respiratory failure (ARF) related to exacerbation of chronic obstructive pulmonary disease, acute cardiogenic pulmonary edema, and immunocompromised states. Several studies have shown that NIV plays a crucial role in reducing the need for endotracheal intubation, length of hospitalization, morbidity, and mortality., It is also used as a prophylactic interventional tool in postextubation patients to prevent re-intubation cases. A patient at high risk of re-intubation may benefit from NIV application; however, close monitoring is essential to detect any indicative signs of extubation failure.
Despite the available evidence supporting the use of NIV, there are still wide variations in its actual utilization worldwide. The success use of NIV in treating ARF patients is not restricted to controlled environment such as Intensive Care Units (ICUs) in hospital settings. NIV can be initiated for patients who suffer from ARF before arrival at hospitals, with less frequent ICUs admission than patients who received standard medical treatment. Similarly, in acute cardiogenic pulmonary edema cases, before arrival in the emergency department, NIV initiated by ambulance staff has resulted in quick improvement in physiological status and reduction in invasive endotracheal intubations in comparison to patients with delayed invasive ventilation until reaching hospital. Prehospital NIV initiation is associated with reduced mortality and reduced rates of endotracheal intubation.,
It is a fact that initiation of NIV in a prehospital level (administered by appropriately trained practitioners) has been shown to be manageable and reduction in dyspnea and intensive care stay, despite the intense workloads of paramedics.
A systematic review published in 2015 has critically evaluated NIV use in ARF at prehospital settings, both from a therapeutic perspective and taking into consideration the cost-effectiveness. The authors have determined that prehospital NIV use was both more clinically effective and more expensive than standard medical care; however, this additional expense was considered cost-effective given that the quality of life and clinical outcome were improved.
More recent research in the area of NIV initiation continues to reflect the benefits of early intervention despite the obstacles and difficulties that some prehospital environments may encounter such as long travel times. However, monitoring the patient during this time is critically needed, highlighting the crucial need for suitably trained professionals to administer NIV in emergency situations. Garuti et al. reported in a prehospital setting that the use of a helmet NIV by an appropriately trained nurse reduced mortality by 94%. Despite the small size of this study, such results would emphasize the importance of rapid initiation of NIV when there is clinical need. Evidence clearly supports using NIV in prehospital settings for better and improved outcomes and should be integrated health-care systems.
NIV is becoming a crucial therapeutic option in the management of acute and nonacute conditions. One essential factor in the success of NIV is early timing of initiation during the condition of respiratory failure. NIV utilization is growing up and becoming a major therapeutic management tool in ICUs, management of chronic respiratory failure at home, clinical wards, and a beneficial option to consider when initiated in a prehospital care.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
AlYami MA, AlAhmari MD, Alotaibi H, AlRabeeah S, AlBalawi I, Mubasher M. Evaluation of efficacy of non-invasive ventilation in non-COPD and non-trauma patients with acute hypoxemic respiratory failure: A systematic review and meta-analysis. Ann Thorac Med 2015;10:16-24.
] [Full text]
Hess DR. Noninvasive positive-pressure ventilation and ventilator-associated pneumonia. Respir Care 2005;50:924-9.
Hess DR, Pang JM, Camargo CA Jr. A survey of the use of noninvasive ventilation in academic emergency departments in the United States. Respir Care 2009;54:1306-12.
Antonelli M, Conti G, Bufi M, Costa MG, Lappa A, Rocco M, et al.
Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: A randomized trial. JAMA 2000;283:235-41.
Kramer N, Meyer TJ, Meharg J, Cece RD, Hill NS. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 1995;151:1799-806.
Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, et al.
Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995;333:817-22.
Diaz O, Iglesia R, Ferrer M, Zavala E, Santos C, Wagner PD, et al.
Effects of noninvasive ventilation on pulmonary gas exchange and hemodynamics during acute hypercapnic exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1997;156:1840-5.
Mehta S, McCool FD, Hill NS. Leak compensation in positive pressure ventilators: A lung model study. Eur Respir J 2001;17:259-67.
Maheshwari V, Paioli D, Rothaar R, Hill NS. Utilization of noninvasive ventilation in acute care hospitals: A regional survey. Chest 2006;129:1226-33.
Roessler MS, Schmid DS, Michels P, Schmid O, Jung K, Stöber J, et al.
Early out-of-hospital non-invasive ventilation is superior to standard medical treatment in patients with acute respiratory failure: A pilot study. Emerg Med J 2012;29:409-14.
Simpson PM, Bendall JC. Prehospital non-invasive ventilation for acute cardiogenic pulmonary oedema: An evidence-based review. Emerg Med J 2011;28:609-12.
Thompson J, Petrie DA, Ackroyd-Stolarz S, Bardua DJ. Out-of-hospital continuous positive airway pressure ventilation versus usual care in acute respiratory failure: A randomized controlled trial. Ann Emerg Med 2008;52:232-41, 241.e1.
Mal S, McLeod S, Iansavichene A, Dukelow A, Lewell M. Effect of out-of-hospital noninvasive positive-pressure support ventilation in adult patients with severe respiratory distress: A systematic review and meta-analysis. Ann Emerg Med 2014;63:600-7.e1.
Schmidbauer W, Ahlers O, Spies C, Dreyer A, Mager G, Kerner T. Early prehospital use of non-invasive ventilation improves acute respiratory failure in acute exacerbation of chronic obstructive pulmonary disease. Emerg Med J 2011;28:626-7.
Pandor A, Thokala P, Goodacre S, Poku E, Stevens JW, Ren S, et al.
Pre-hospital non-invasive ventilation for acute respiratory failure: A systematic review and cost-effectiveness evaluation. Health Technol Assess 2015;19:v-vi, 1-102.
Hubble MW, Richards ME, Wilfong DA. Estimates of cost-effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema. Prehosp Emerg Care 2008;12:277-85.
Nielsen VM, Rasmussen BS, Madsen J, Aasen A, Toft-Petersen AP, Lübcke K, et al.
Prehospital treatment with continuous positive airway pressure in patients with acute respiratory failure: A regional observational study. Scand J Trauma Resusc Emerg Med 2016;24:121.
Garuti G, Bandiera G, Cattaruzza MS, Gelati L, Osborn JF, Toscani S, et al.
Out-of-hospital helmet CPAP in acute respiratory failure reduces mortality: A study led by nurses. Monaldi Arch Chest Dis 2010;73:145-51.