Prehospital CPAP for Acute Respiratory Distress Syndrome

R. Eleanor Anderson, MD

A systematic review of controlled trials suggests that CPAP reduces need for intubation.

Continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are commonly used in-hospital therapies for respiratory failure, predominantly in patients with chronic obstructive pulmonary disease and pulmonary edema. To examine whether use of CPAP or NIV in the prehospital setting reduces mortality, length of stay, or need for intubation, researchers conducted a systematic review of controlled trials.

Of 12 studies that met inclusion criteria, only four — all pertaining to CPAP — had acceptable power and risk of bias. Of these four studies, two included patients with acute respiratory distress of any etiology, and two included patients with acute pulmonary edema. One small, randomized, controlled trial (69 patients) showed a reduction in intubation rate in the prehospital CPAP group versus the standard medical treatment group (odds ratio, 0.16) and a reduction in mortality (OR, 0.3). None of the four studies showed differences in length of stay in the hospital or intensive care unit.

Citation(s):

Bakke SA et al. Continuous positive airway pressure and noninvasive ventilation in prehospital treatment of patients with acute respiratory failure: A systematic review of controlled studies. Scand J Trauma Resusc Emerg Med. 2014 Nov; 22:69.