Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-29T01:41:53.112Z Has data issue: false hasContentIssue false
  • English
  • Français

Factors Associated with Failure of Non-invasive Positive Pressure Ventilation in a Critical Care Helicopter Emergency Medical Service

Published online by Cambridge University Press:  27 February 2015

James S. Lee ,
Domhnall O’Dochartaigh ,
Mark MacKenzie ,
Darren Hudson ,
Stephanie Couperthwaite ,
Cristina Villa-Roel  and
Brian H. Rowe
James S. Lee*
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
Domhnall O’Dochartaigh
Affiliation:
Shock Trauma Air Rescue Society, Edmonton, Alberta, Canada
Mark MacKenzie
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada Shock Trauma Air Rescue Society, Edmonton, Alberta, Canada Alberta Health Services Emergency Medical Services, Edmonton, Alberta, Canada
Darren Hudson
Affiliation:
Shock Trauma Air Rescue Society, Edmonton, Alberta, Canada Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
Stephanie Couperthwaite
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
Cristina Villa-Roel
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada School of Public Health, University of Alberta, Edmonton, Alberta, Canada
Brian H. Rowe
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada School of Public Health, University of Alberta, Edmonton, Alberta, Canada
*
Correspondence: James Lee Department of Emergency Medicine University of Alberta 750 University Terrace, 8303 112 Street Edmonton, Alberta, Canada T6G 2T4 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Non-invasive positive pressure ventilation (NIPPV) is used to treat severe acute respiratory distress. Prehospital NIPPV has been associated with a reduction in both in-hospital mortality and the need for invasive ventilation.

Hypothesis/Problem

The authors of this study examined factors associated with NIPPV failure and evaluated the impact of NIPPV on scene times in a critical care helicopter Emergency Medical Service (HEMS). Non-invasive positive pressure ventilation failure was defined as the need for airway intervention or alternative means of ventilatory support.

Methods

A retrospective chart review of consecutive patients where NIPPV was completed in a critical care HEMS was conducted. Factors associated with NIPPV failure in univariate analyses and from published literature were included in a multivariable, logistic regression model.

Results

From a total of 44 patients, NIPPV failed in 14 (32%); a Glasgow Coma Scale (GCS) <15 at HEMS arrival was associated independently with NIPPV failure (adjusted odds ratio 13.9; 95% CI, 2.4-80.3; P=.003). Mean scene times were significantly longer in patients who failed NIPPV when compared with patients in whom NIPPV was successful (95 minutes vs 51 minutes; 39.4 minutes longer; 95% CI, 16.2-62.5; P=.001).

Conclusion

Patients with a decreased level of consciousness were more likely to fail NIPPV. Furthermore, patients who failed NIPPV had significantly longer scene times. The benefits of NIPPV should be balanced against risks of long scene times by HEMS providers. Knowing risk factors of NIPPV failure could assist HEMS providers to make the safest decision for patients on whether to initiate NIPPV or proceed directly to endotracheal intubation prior to transport.

LeeJS , O’DochartaighD , MacKenzieM , HudsonD , CouperthwaiteS , Villa-RoelC , RoweBH . Factors Associated with Failure of Non-invasive Positive Pressure Ventilation in a Critical Care Helicopter Emergency Medical Service. Prehosp Disaster Med2015; 30(2): 1–5

Keywords

HEMSNIPPVnon-invasive ventilationrespiratory failure
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 3 , June 2015 , pp. 239 - 243
Copyright
© World Association for Disaster and Emergency Medicine 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Ram, FSF, Picot, J, Lightowler, J, Wedzicha, JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Syst Rev. 2004;(3):CD004104.Google Scholar
2. Vital, FMR, Saconato, H, Ladeira, MT, et al. Non-invasive positive pressure ventilation (CPAP or bi-level NPPV) for cardiogenic pulmonary edema. Cochrane Database of Syst Rev. 2008;(3):CD005351.Google Scholar
3. Roesslaer, M, Schmid, D, Michels, P, 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(5):409-414.Google Scholar
4. Simpson, P, Bendall, J. Prehospital non-invasive ventilation for acute cardiogenic pulmonary oedema: an evidence-based review. Emerg Med J. 2011;28(7):609-612.Google Scholar
5. Plaisance, P, Pirrachio, R, Berton, C, Vicault, E, Payen, D. A randomized study of out-of-hospital continues positive airway pressure for acute cardiogenic pulmonary oedema: physiological and clinical effects. Eur Heart J. 2007;28(23):2895-2901.Google Scholar
6. 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 control trial. Ann Emerg Med. 2008;52(3):232-241.Google Scholar
7. Gay, P. Complications of non-invasive ventilation in acute care. Respir Care. 2009;54(2):246-258.Google Scholar
8. National Association of EMS Physicians. Position Statement: Non-invasive Positive Pressure Ventilation. http://www.naemsp.org/documents/NIPPVPosition.pdf. Published December 21, 2010. Accessed October 3, 2012.Google Scholar
9. Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research Electronic Data Capture (REDCap) - a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381.Google Scholar
10. Mal, S, McLeod, S, Iansavichene, A, Dukelow, A, Lewell, M. Effect of out-of-hospital non-invasive positive-pressure support ventilation in adult patients with severe respiratory distress: a systemic review and meta-analysis. Ann Emerg Med. 2014;63(5):600-607.Google Scholar
11. Le Cong, M, Robertson, A. A 3-year retrospective audit of the use of non-invasive positive pressure ventilation via the Oxylog 3000 transport ventilator during air medical retrievals. Air Med J. 2013;32(3):126-128.Google Scholar
12. Merlani, PG, Pasquin, P, MGranier, JM, Treggiari, M, Rutschmann, O, Ricou, B. Factors associated with failure of non-invasive positive pressure ventilation in the emergency department. Acad Emerg Med. 2005;12(12):1206-1215, 10.Google Scholar
13. Confalonieri, M, Garuti, G, Cattaruzza, MS, et al. A chart of failure risk for non-invasive ventilation in patients with COPD exacerbation. Eur Resp J. 2005;25(2):348-355.CrossRefGoogle ScholarPubMed
14. Schettino, G, Altobelli, N, Kacmarek, RM. Non-invasive positive-pressure ventilation in acute respiratory failure outside clinical trials: experience at the Massachusetts General Hospital. Crit Care Med. 2008;36(2):441-447.Google Scholar
15. Worster, A, Haines, T. Advanced statistics: understanding medical record review (MRR) studies. Acad Emerg Med. 2004;11(2):187-192.Google Scholar