Non-Invasive Ventilation as a Therapy Option for Acute Exacerbations of Chronic Obstructive Pulmonary Disease and Acute Cardiopulmonary Oedema in Emergency Medical Services

Felix C F Schmitt; Daniel Gruneberg; Niko R E Schneider; Jan-Ole Fögeling; Moritz Leucht; Felix Herth; Michael R Preusch; Werner Schmidt; Christian Bopp; Thomas Bruckner; Markus A Weigand; Stefan Hofer; Erik Popp

doi:10.3390/jcm11092504

Non-Invasive Ventilation as a Therapy Option for Acute Exacerbations of Chronic Obstructive Pulmonary Disease and Acute Cardiopulmonary Oedema in Emergency Medical Services

J Clin Med. 2022 Apr 29;11(9):2504. doi: 10.3390/jcm11092504.

Affiliations

¹ Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany.
² Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, 69126 Heidelberg, Germany.
³ Department of Internal Medicine III, Cardiology, University of Heidelberg, 69120 Heidelberg, Germany.
⁴ Department of Anesthesiology and Intensive Care Medicine, Thoraxklinik, University of Heidelberg, 69126 Heidelberg, Germany.
⁵ Department of Anesthesiology and Intensive Care, GRN Hospital Schwetzingen, 68723 Schwetzingen, Germany.
⁶ Institute of Medical Biometry and Informatics (IMBI), Heidelberg University, 69120 Heidelberg, Germany.
⁷ Department of Anesthesiology, Kaiserslautern Westpfalz Hospital, 67655 Kaiserslautern, Germany.

Abstract

In this observational prospective multicenter study conducted between October 2016 and October 2018, we tested the hypothesis that the use of prehospital non-invasive ventilation (phNIV) to treat patients with acute respiratory insufficiency (ARI) caused by severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and acute cardiopulmonary oedema (ACPE) is effective, time-efficient and safe. The data were collected at four different physician response units and three admitting hospitals in a German EMS system. Patients with respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease and acute cardiopulmonary oedema were enrolled. A total of 545 patients were eligible for the final analysis. Patients were treated with oxygen supplementation, non-invasive ventilation or invasive mechanical ventilation. The primary outcomes were defined as changes in the clinical parameters and the in-hospital course. The secondary outcomes included time efficiency, peri-interventional complications, treatment failure rate, and side-effects. Oxygenation under phNIV improved equally to endotracheal intubation (ETI), and more effectively in comparison to standard oxygen therapy (SOT) (paO2 SOT vs. non-invasive ventilation (NIV) vs. ETI: 82 mmHg vs. 125 mmHg vs. 135 mmHg, p-value SOT vs. NIV < 0.0001). In a matched subgroup analysis phNIV was accompanied by a reduced time of mechanical ventilation (phNIV: 1.8 d vs. ETI: 4.2 d) and a shortened length of stay at the intensive care unit (3.4 d vs. 5.8 d). The data support the hypothesis that the treatment of severe AECOPD/ACPE-induced ARI using prehospital NIV is effective, time efficient and safe. Compared to ETI, a matched comparison supports the hypothesis that prehospital implementation of NIV may provide benefits for an in-hospital course.

Keywords: acute cardiopulmonary oedema; acute exacerbated COPD; acute respiratory insufficiency; emergency medical service; prehospital non-invasive ventilation.

Grants and funding

This research received no external funding.